The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries: A preliminary prospective longitudinal study of the healing process.
Abstract: The objective assessment of the mechanical properties of the superficial digital flexor tendon (SDFT) could provide useful information for the rehabilitation of horses with SDFT injuries. Assessment of strain ratio (the strain of a standard reference divided by that of lesions) is a quantitative method in sonoelastography for evaluating tissue stiffness in vivo. As yet, no longitudinal studies have used strain ratio to evaluate the progression of stiffness in SDFT injuries. Objective: To test the hypothesis that strain ratio can evaluate the recovery of stiffness during the healing of SDFT injuries. Methods: Prospective and longitudinal study with observer-blinded evaluation. Methods: Ultrasonography, including sonoelastography, was performed in seven Thoroughbred horses with naturally occurring SDFT injuries at five time points: within 20 days of the injury, and at 2, 3, 6 and 9 months after the injury. Blinded sonoelastographic images were independently evaluated by two veterinarians to assess interobserver agreement. The recovery of stiffness and echogenicity in lesions were evaluated using the strain ratio and grey-scale ratio (echogenicity of lesions divided by that of the surrounding area), respectively. Results: Interobserver agreement was assessed as 'almost perfect'. Strain ratios were significantly higher at 9 months after injury than at the other time points (all P<0.05). Strain ratios at 6 months after injury were significantly higher than those at earlier time points (P<0.05). Grey-scale ratios within 20 days of injury were significantly lower than those at the other time points (all P<0.05). Conclusions: Validations of SDFT status were evaluated only by recovery of the echogenicity in lesions and not by histopathological examination. Conclusions: Although further studies are needed to validate the relationships between injured SDFT status and sonoelastographic findings, this preliminary study shows that strain ratio may provide a means to monitor the recovery of stiffness in lesions during rehabilitation, even when the grey-scale ratio remains unchanged from a few months after SDFT injury. The Summary is available in Chinese - see Supporting Information.
© 2017 EVJ Ltd.
Publication Date: 2017-02-16 PubMed ID: 28083881DOI: 10.1111/evj.12665Google Scholar: Lookup
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- Journal Article
- Clinical Study
- Diagnosis
- Diagnostic Technique
- Disease Diagnosis
- Equine Diseases
- Equine Health
- Equine Science
- Horses
- In Vivo
- Injury
- Longitudinal Study
- Musculoskeletal System
- Observational Study
- Rehabilitation
- Superficial Digital Flexor Tendon
- Tendons
- Thoroughbreds
- Ultrasound
- Veterinary Medicine
- Veterinary Procedure
- Veterinary Research
Summary
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This research investigates using a technique called sonoelastography to measure strain ratio and thereby determine the recovery of soft tissue stiffness in horse tendons after injury. The preliminary study shows successful results through the use of this method.
Research Objective
- The goal of this research was to test if the use of a strain ratio, as measured by sonoelastography, could be an effective way to objectively measure the recovery of stiffness in a horse’s superficial digital flexor tendon after an injury.
Research Methods
- This was a prospective and longitudinal study carried out on seven Thoroughbred horses with naturally occurring SDFT injuries.
- The study was conducted at five different points in time: within 20 days of the injury, and then at 2, 3, 6, and 9 months post-injury.
- To maintain accuracy, the images produced through sonoelastography were independently evaluated by two veterinarians, who were both unaware of each other’s evaluations.
- The recovery of stiffness and echogenicity (reflected ultrasonic waves) in the lesions were evaluated using two methods: the strain ratio (strain of the lesions divided by a standard reference) and grey-scale ratio (echogenicity of lesions divided by that of the surrounding area).
Research Results
- The agreement between the two independent veterinarian observers was found to be ‘almost perfect’ indicating a high level of reliability in the data gathered.
- The results showed strain ratios significantly higher at 9 months post-injury than other time points, indicating progression towards recovery.
- The grey-scale ratio was lowest within 20 days of injury and increased significantly at future time points.
Research Conclusions
- The validity of the SDFT status was evaluated by the recovery of echogenicity in the lesions, not by histopathological examination (study of disease in tissues).
- While further research is necessary to further validate the relationships between injured SDFT status and sonoelastographic findings, the preliminary results suggest that strain ratio could be used to monitor tendon stiffness recovery during the rehabilitation process, even when the grey-scale ratio doesn’t change significantly.
- The authors emphasize the exploratory nature of this study and underline the need for further research to prove and solidify the results.
Cite This Article
APA
Tamura N, Nukada T, Kato T, Kuroda T, Kotoyori Y, Fukuda K, Kasashima Y.
(2017).
The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries: A preliminary prospective longitudinal study of the healing process.
Equine Vet J, 49(5), 590-595.
https://doi.org/10.1111/evj.12665 Publication
Researcher Affiliations
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan.
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan.
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan.
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan.
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan.
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan.
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan.
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan.
MeSH Terms
- Animals
- Elasticity Imaging Techniques / methods
- Elasticity Imaging Techniques / veterinary
- Horses / injuries
- Longitudinal Studies
- Prospective Studies
- Tendon Injuries / diagnostic imaging
- Tendon Injuries / physiopathology
- Tendon Injuries / veterinary
- Tendons
- Wound Healing
Citations
This article has been cited 8 times.- Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L. 2D-SWE of the Metacarpophalangeal Joint Capsule in Horses. Vet Sci 2022 Sep 4;9(9).
- Straticò P, Guerri G, Palozzo A, Di Francesco P, Vignoli M, Varasano V, Petrizzi L. Elastosonographic features of the metacarpophalangeal joint capsule in horses. BMC Vet Res 2021 May 29;17(1):202.
- Secchi V, Masala G, Corda A, Corda F, Potop E, Barbero Fernandez A, Pinna Parpaglia ML, Sanna Passino E. Strain Elastography of Injured Equine Superficial Digital Flexor Tendons: A Reliability Study of Manual Measurements. Animals (Basel) 2021 Mar 12;11(3).
- Serrani D, Volta A, Cingolani F, Pennasilico L, Di Bella C, Bonazzi M, Salvaggio A, Palumbo Piccionello A. Serial Ultrasonographic and Real-Time Elastosonographic Assessment of the Ovine Common Calcaneal Tendon, after an Experimentally Induced Tendinopathy. Vet Sci 2021 Mar 25;8(4).
- Kornicka-Garbowska K, Pędziwiatr R, Woźniak P, Kucharczyk K, Marycz K. Microvesicles isolated from 5-azacytidine-and-resveratrol-treated mesenchymal stem cells for the treatment of suspensory ligament injury in horse-a case report. Stem Cell Res Ther 2019 Dec 18;10(1):394.
- Ackerman JE, Studentsova V, Myers M, Buckley MR, Richards MS, Loiselle AE. Non-Invasive Ultrasound Quantification of Scar Tissue Volume Identifies Early Functional Changes During Tendon Healing. J Orthop Res 2019 Nov;37(11):2476-2485.
- Palumbo Piccionello A, Pennasilico L, Tambella AM, Sassaroli S, Galosi M, Pilati N, Dini F. Radiographic, Ultrasonographic and Shear Elastosonographic Changes in Patellar Ligament in Dogs Undergoing Tibial Plateau Leveling Osteotomy. Vet Sci 2025 Aug 11;12(8).
- Li H, Li Y, Luo S, Zhang Y, Feng Z, Li S. The roles and mechanisms of the NF-κB signaling pathway in tendon disorders. Front Vet Sci 2024;11:1382239.
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