Article

Differential motion between the plantaris and Achilles tendons has
been hypothesized to contribute to pain in some patients presenting with Achilles
tendinopathy. However, objective evidence of differential Achilles-plantaris
motion is currently lacking from the literature. OBJECTIVE:
To determine whether
differential, multidirectional motion exists between the plantaris tendon (PT)
and Achilles tendon (AT) as documented by dynamic ultrasound (US) and
postdissection examination in an unembalmed cadaveric model. DESIGN: Prospective,
cadaveric laboratory investigation. SETTING: Procedural skills laboratory in a
tertiary medical center. SUBJECTS: Twenty unembalmed knee-ankle-foot specimens (9
right, 11 left) obtained from 6 male and 10 female donors ages 55-96 years (mean
80 years) with body mass indices of 14.1-33.2 kg/m2 (mean 22.5 kg/m2). METHODS: A
single, experienced operator used high-resolution dynamic US to qualitatively
document differential PT-AT motion during passive ankle
dorsiflexion-plantarflexion. Specimens were then dissected and passive
dorsiflexion-plantarflexion was repeated while differential PT-AT motion was
visualized directly. MAIN OUTCOME MEASUREMENTS: Presence or absence of
multidirectional differential PT-AT motion. RESULTS: All 20 specimens exhibited
smooth but variable amplitude multidirectional differential PT-AT motion. Whereas
US readily demonstrated medial-lateral and anterior-posterior PT motion relative
to the AT, differential longitudinal motion was only appreciated on dissection
and direct inspection. Many specimens exhibited partial or complete encasement of
the PT between the gastrocnemius portion of the AT and the soleus aponeurosis.
CONCLUSION: Some degree of multidirectional differential PT-AT motion appears to
be a normal phenomenon, and PT motion can be evaluated sonographically in both
the medial-lateral and anterior-posterior directions. The existence of normal
differential PT-AT motion suggests that alterations in PT motion or repetitive
stress within the PT-AT interval may produce symptoms in some patients presenting
with Achilles region pain syndromes. The PT should be evaluated in all patients
presenting with Achilles, plantaris, or calf pain syndromes. Future research
would benefit from the development of a sonographic classification system for PT
anatomy and motion with the goal of differentiating normal versus pathologic
states and identifying risk factors for symptom development.
LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS