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Ultraschall Med 2012; 33(6): 581-586
DOI: 10.1055/s-0032-1325526
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© Georg Thieme Verlag KG Stuttgart · New York

Sonoelastography Can Be Used to Monitor the Restoration of Achilles Tendon Elasticity after Injury

Der Einsatz der Sonoelastografie für das Monitoring der Sehnenelastizität nach Achillessehnendefekt
S. Gehmert
5   Plastische Chirurgie, Universität Regensburg
,
E. M. Jung
1   Insitut für Röntgendiagnostik, Universitätsklinikum Regensburg
,
T. Kügler
2   Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg
,
S. Klein
2   Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg
,
S. Gehmert
3   Department of Obstetrics and Gynecology, University Medical Center Regensburg
,
K. Zeitler
4   Department of Pathology, University Medical Center Regensburg
,
M. Loibl
2   Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg
,
L. Prantl
5   Plastische Chirurgie, Universität Regensburg
› Author Affiliations
Further Information

Publication History

17 June 2012

06 October 2012

Publication Date:
07 December 2012 (online)

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Sonoelastography Can Be Used to Monitor the Restoration of Achilles Tendon Elasticity after InjuryUltraschall Med 2012; 33(06): 581-586
DOI: 10.1055/s-0032-1330547

Abstract

Purpose: The aim of the current study was to evaluate an ultrasound approach for depicting elastic recovery after stem cell application on injured Achilles tendons.

Materials and Methods: A rabbit Achilles tendon injury model was used and randomized hind limbs received an extracellular matrix either with autologous mesenchymal stem cells (group 2, n = 6) or without (group 3, n = 6). The cells were harvested from the rabbits’ nuchal fat body. Untreated Achilles tendons (group 1, n = 6) served as controls. Specimens were harvested after 8 weeks and analyzed longitudinally for elasticity using a high resolution 6 – 15 MHz matrix linear probe. For each tendon, real-time color-coded sonoelastography sequences were recorded for 20 seconds and 10 color histogram frames were obtained. Defined regions of interest (ROIs) were placed on the injury (n = 3) and on the adjacent uninjured tendon tissue (n = 3). In total, 180 measurements were obtained for semi-quantitative analysis.

Results: Repeated measures ANOVA demonstrated a higher elasticity for the stem cell-seeded matrix (group 2) in comparison to the unseeded matrix (group 3) (p < 0.001). No significant difference was found between the injured tendon tissue treated with stem cell-seeded matrix (group 2) and the uninjured Achilles tendons (group 1) (p > 0.05). Moreover, no differences were found between the measurements at different points in time (p > 0.05).

Conclusion: Our results indicate that autologous mesenchymal stem cell application successfully restores the mechanical properties of injured tendon tissue. Furthermore, sonoelastography makes it possible to monitor the elasticity of injured Achilles tendons.

Zusammenfassung

Ziel: Ziel der Studie war es, die Elastizität von Achillessehnengewebe nach autologer mesenchymaler Stammzellapplikation unter Verwendung der Sonoelastografie zu untersuchen.

Material und Methoden: Die Achillessehne beider Hinterläufe wurde in neun Neuseelandkaninchen durchtrennt und randomisiert drei Gruppen zugeteilt, wobei eine extrazelluläre Matrix mit Stammzellen (Gruppe 2, n = 6) und ohne Stammzellen (Gruppe 3, n = 6) verwendet wurde. In der Kontrollgruppe wurde eine Shame-Operation durchgeführt (Gruppe 1, n = 6). Die Extraktion der Stammzellen erfolgte aus dem nuchalen Fettkörper. Nach 8 Wochen die Elastizität der Sehnen mit einer hochauflösenden 6 – 15 MHz Matrix-Linear-Sonde untersucht. Für jede Sehne wurde eine 20 Sekunden farbkodierte Sonoelastografiesequenz aufgezeichnet und 10 Farbhistogramme untersucht. Definierte Regions of Interests (ROIs) wurden über den Sehnendefekt (n = 3) und über angrenzendes vitales Sehnengewebe (n = 3) gelegt. Für die semiquantitativen Auswertungen wurden 180 Einzelmessungen aufgezeichnet und ausgewertet.

Ergebnisse: In Gruppe 2 konnte für Achillessehnen mit beladener Matrix eine höhere Elastizität im Vergleich zu Achillessehnen mit unbeladener Matrix in Gruppe 3 gemessen werden (p < 0,001; ANOVA). Hinsichtlich des Elastizitätsindex (EI) von unbehandeltem Sehnengewebe (Gruppe 1) und Sehnengewebe mit beladener Matrix (Gruppe 2) konnte kein Unterschied gefunden werden (p > 0,05). Für alle Einzelmessungen der verschiedenen Messzeitpunkte konnte kein signifikanter Unterschied festgestellt werden (p > 0,05).

Schlussfolgerung: Die Applikation von autologen mesenchymalen Stammzellen aus Fettgewebe hat zu einer vollständigen Wiederherstellung der Elastizität des Sehnengewebes nach Achillessehnenverletzung geführt. Die Sonoelastografie eignet sich die Regeneration der Elastizität nach Achillessehnenverletzung zu beurteilen.

Key words

tendons - ultrasound - animal investigations - adipose tissue-derived stem cells
 

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