Background
Method
Information source and search strategy
Eligibility criteria and study selection
Inclusion Criteria | Exclusion Criteria | |
---|---|---|
Population | Participants over the age of 18 | Participants with insertion AT, history of tendon rupture, past tendon surgery or other causes of heel pain |
Physically active and sedentary | ||
Healthy participants and those identified as having mid-portion Achilles tendinopathy | ||
Study type | Studies of any design, especially tool development or validation studies | Studies that only used elastography as an outcome measurement without taking into consideration the measurement properties |
The measurement properties of different elastography methods included reliability, measurement error, validity and responsiveness | Non-peer-reviewed papers, such as editorials or letters to the editor | |
Studies investigating the Achilles tendon together with other tendons or muscles but providing separate results for different areas | Studies investigating the Achilles tendon together with other tendons or muscles but presenting results for the whole cohort | |
Scientific papers in peer-reviewed journals | In vitro or cadaveric studies |
Data extraction
Methodological quality evaluation of the studies
Results
Search strategy
Study characteristics
Measurement instrument | Authors & year | Participants Characteristics | |||
---|---|---|---|---|---|
Gender (Male: Female) | Age range Mean ± SD (years) | Study population | Physical activity level | ||
Strain elastography | Drakonaki et al., 2009 [33] | 13 M:12F | range 20–52 38.8 ± 5.0 | Healthy tendon | NR |
Ooi et al., 2015 [27] | 90 M:30F | 44.9 ± 13.6 | Healthy tendon | occasional recreational sports | |
45.2 ± 13.1 | Achilles tendinopathy | occasional recreational sports | |||
Yamamoto et al., 2016 [34] | 16 M:9F | range 21–38 28.0 | Healthy tendon | < 1 day per week | |
Schneebeli et al., 2016 [35] | 10 M:14F | 28.8 ± 8.8 | Healthy tendon | NR | |
Payne et al., 2017 [32] | 4 M:4F | 25.5 ± 2.5 | Healthy tendon | normal daily walking | |
Schneebeli et al., 2019 [36] | 18 M:19 F | 27.1 ± 7.0 | Healthy tendon | not controlled | |
Schneebeli et al., 2021 [37] | 12 M:8F | 28.9 ± 4.16 | Healthy tendon | NR | |
Shear wave elastography—velocity | Aubry et al., 2013 [38] | 37 M:43F | range 20–83 45.4 | Healthy tendon | 37 not active, 43 > 1 h per week |
DeWall et al., 2014 [39] | 5 M:5F | 26.7 ± 4.1 | Healthy tendon | NR | |
Aubry et al. 2015 [28] | 68 M:12F | range 31–57 | Healthy tendon | NR | |
19 M:6F | range 46–63 | Achilles tendinopathy | NR | ||
Dirrichs et al., 2016 [29] | 26 M:15F | 42 ± 13.4 | Healthy tendon & Achilles tendinopathy | NR | |
Fu et al., 2016 [40] | 165 M:161F | range 19–88 48.8 ± 17.1 | Healthy tendon | NR | |
Payne et al., 2017 [32] | 7 M:7F | 26.5 ± 3.8 | Healthy tendon | normal daily walking | |
Coombes et al., 2018 [30] | 11 M:17F | 38.3 ± 16.7 | Healthy tendon | physically active | |
13 M:9F | 47.5 ± 11.4 | Achilles tendinopathy | |||
Shear wave elastography—modulus | Helfenstein-Didier et al., 2016 [41] | 12 M:0F | 23.2 ± 3.3 | Healthy tendon | NR |
Lima et al., 2017 [42] | 24 M:0F | 28.0 ± 2.0 | Healthy tendon | various levels but consistent during testing | |
Zhou et al., 2019 [43] | 14 M:6F | 22.5 ± 3.0 | Healthy tendon | normal daily walking | |
Gatz et al., 2021 [31] | 18 M:19F | range 21–69 37.0 ± 14.0 | Healthy tendon | 3.2 ± 2.4 h active per week | |
16 M:22F | range 22–75 46.0 ± 14.0 | Achilles tendinopathy | 2.3 ± 2.7 h active per week | ||
cSWE | Suydam et al., 2015 [44] | 29—gender NR | 29.0 ± 9.5 | Healthy tendon | NR |
Corrigan et al., 2019 [45] | 11 M:9F | 29.0 ± 4 | Healthy tendon | NR | |
3D SWE | Götschi et al., 2021 [46] | 6 M:4F | 28.1 ± 3.0 | Healthy tendon | physically active > 30 min of moderate activity per week |
Measurement instrument | Authors & year | Machine | Probe | Reference material |
---|---|---|---|---|
Strain elastography | Drakonaki et al., 2009 [33] | HV900, Hitachi Medical Corporation | 6-14MHz linear transducer | Kager’s fat pad |
Ooi et al., 2015 [27] | Philips iU22 Philips Healthcare, Bothell | 5-17MHz linear probe | Kager’s fat pad | |
Yamamoto et al., 2016 [34] | HV900; Hitachi Aloka Medical Corporation | 6–14MHz linear probe | acoustic coupler—elastomer resin | |
Schneebeli et al., 2016 [35] | MyLab ClassC, Esaote, Genoa, Italy | 3–13 MHz linear probe | external reference material | |
Payne et al., 2017 [32] | Siemens ACUSON S2000™ HELX EVOLUTION | linear 5-14MHz probe | no reference material was used. For analysis, raw data measuring the actual displacement used | |
Schneebeli et al., 2019 [36] | MyLab Class C, Esaote, Genova | linear 3-13MHz probe | external reference material | |
Schneebeli et al., 2021 [37] | 1. Resona 7, Mindray, Shenzhen; 2.Aplio 500, Toshiba Medical Systems Corp.; 3.Aixplorer, SuperSonic Imagine, Aix-En-Provence, | linear—1.6-14MHz; 2. 5-14MHz; 3. 4–15MHz probe | acoustic coupler—elastomer resin | |
Shear wave elastography—velocity | Aubry et al., 2013 [38] | SuperSonic Imagine, Aix-En-Provence, France) | 12-MHz superficial Linear transducer | NA |
DeWall et al., 2014 [39] | SupersonicImagine;Aix-en-Provence,France;software version 5 | linear array transducer(L15-4) | NA | |
Aubry et al. 2015 [28] | Aixplorer, SuperSonic Imagine, Aix-en-Provence, France | 12-MHz superficial linear transducer | NA | |
Dirrichs et al., 2016 [29] | Aixplorer, SuperSonic Imagine, Aix-en-Provence, France | linear 15 MHz transducer (SuperLinear SL15-4, SuperSonic Imagine | NA | |
Fu et al., 2016 [40] | Acuson S3000 ultrasound system (Siemens Medical Solutions VTIQ; Siemens Medical Solutions, Malvern, PA) | 9L4 linear transducer | NA | |
Payne et al., 2017 [32] | Siemens ACUSON S2000™ HELX EVOLUTION | linear 4-9MHz probe | NA | |
Coombes et al., 2018 [30] | Aixplorer version 8.2; Supersonic Imagine, Aix-en-Provence, France) | 50 mm linear transducer (15–4 MHz) | NA | |
Shear wave elastography—modulus | Helfenstein-Didier et al., 2016 [41] | AIXPLORER v8, Supersonic Imagine, Aix-en-Provence | superlinear 14–5/38 mm | NA |
Lima et al., 2017 [42] | AIXPLORER v.9, Supersonic Image, Aix-en-Provence | superlinear 4-15 MHz and 2-10 MHz probes | NA | |
Zhou et al., 2019 [43] | AIXPLORER, Supersonic Imagine, Aix-en-Provence | 10-2MHz/40 mm linear array transducer | NA | |
Gatz et al., 2021 [31] | Aixplorer, Super-Linear SL 18–5; Supersonic Imagine | superlinear 18–5 | NA | |
cSWE | Suydam et al., 2015 [44] | MDP, Ultrasonix, Vancouver | linear 38 mm and external actuator | NA |
Corrigan et al., 2019 [45] | SonixMDP Q + , Ultrasonix, Vancouver | linear L14-5/38mm and external actuator | NA | |
3D SWE | Götschi et al., 2021 [46] | Aixplorer Ultimate SuperSonic Imagine | super linear 18-5MHz/50mm | NA |
Quality of review articles—methodological quality
Outcome Measurement Instrument | Author and year | Reliability | Measurement Error | ||||||
---|---|---|---|---|---|---|---|---|---|
Study population | Design | Cosmin Rate | Statistical Results | Measurement property ratings based on statistical results | Cosmin Rate | Statistical Results | Measurement property ratings based on statistical results | ||
Strain elastography | Drakonaki et al., 2009 [33] | 25 bilateral | Inter-rater same day | Adequate | ICC T = 0.41 L = 0.51 | - | Adequate | CV T = 30% L = 29.6% | ? |
Intra rater same day | ICC T = 0.41,0.45 L = 0.78,0.66 | + | CV T = 39% L = 30.50% | ? | |||||
Ooi et al., 2015 [27] | 10 bilateral | Inter rater different days | Very good | ICC = 0.79 | + | NA | NA | NA | |
Intra rater different days | Very good | ICC = 0.87 | + | ||||||
Yamamoto et al., 2016 [34] | 25 bilateral | Inter rater same day | Doubtful | Spearman = 0.61 | NA | Adequate | SEM = 0.06,0.07 | ? | |
Intra rater same day | Adequate | ICC = 0.93 ICC = 0.87 | + | ||||||
Schneebeli et al., 2016 [35] | 24 bilateral | Intra rater same day | Adequate | ICC relaxed = 0.87 ICC contracted = 0.94 | + | NA | NA | NA | |
Payne et al., 2017 [32] | 8 right | Intra rater same day Intra rater different days | Adequate | ICC T = 0.00–0.11, L = 0.01–0.11 both foot position | - | Adequate | CV L = 80.8%-111.5% T = 53.6—112.4% | ? | |
Shear wave elastography—velocity | Aubry et al., 2013 [38] | 30 bilateral | Inter-rater same day | Doubtful | ICC L = -0.011–0.46, T-0.062–0.29 | NA | NA | NA | NA |
DeWall et al., 2014 [39] | 10 feet side not reported | Inter-rater | Doubtful | CV = 0.156 | NA | NA | NA | NA | |
Fu et al., 2016 [40] | 326 bilateral | Inter-rater same day | Adequate | ICC L = 0.923, T = 0.870 | + | NA | NA | NA | |
3 dominant foot | Inter-rater same day | Very good | ICC T-0.70 L-0.80 | + | Very good | SEM T = 0.19–0.26 L = 0.19–0.27 CV T = 3.9–6.3% L = 2.9–5.2% | ? | ||
14 dominant foot | Intra rater same day Intra rater different days | ICC T = 0.62–0.85, L = 0.45–0.71 | - | ||||||
Coombes et al., 2018 [30] | 6 bilateral | Inter session different days | Very good | ICC = 0.71 | + | NA | NA | NA | |
Götschi et al., 2021 [46] | 10 right | Inter rater different days | Adequate | ICC = 0.455 | - | Adequate | SEM = 1.043 m/s | ? | |
Inter session different days | Adequate | ICC = 0.591 | - | Adequate | SEM = 1.068 m/s | ? | |||
Shear wave elastography—modulus | Helfenstein-Didier et al., 2016 [41] | 7 right | Intra session same day | Adequate | ICC s = 1.0 kPa c = 0.42–0.85 MPa | - | Adequate | SEM s = 1.37–2.14 kPa, c = 3.5–10.69 MPa | ? |
Lima et al., 2017 [42] | 24 bilateral | Intra session different days | Doubtful | ICC = 0.82–0.93 | NA | Doubtful | CV = 23–25% | NA | |
Inter sessions different days | ICC = 0.42–0.60 to isometric contraction | ||||||||
Zhou et al., 2019 [43] | 20 dominant foot | Inter rater different days | Very good | ICC = 0.76–0.94 | + | Very good | SEM = 14.38–15.78 kPa | + | |
Intra rater different days | ICC = 0.77–0.93 | + | SEM = 11.87–21.75 kPa | + | |||||
cSWE | Suydam et al., 2015 [44] | 29 bilateral | Intra rater same day | Adequate | ICC s = 0.875, v = 0.876 | + | Adequate | SEM s = 3.8 kPa v = 6.8Pas | + |
Corrigan et al., 2019 [45] | 20 either right or left | Intra rater same day Intra rater different days | Adequate | ICC s = 0.697, v = 0.856, d = 0.855 | + | Adequate | SEM s = 8.28 kPa, v = 4.79 Pas, d = 46.72 kPa | ? | |
3D SWE | Götschi et al., 2021 [46] | 10 right | Inter rater different days | Adequate | ICC = 0.436 | - | Adequate | SEM = 0.553 m/s | ? |
Inter sessions different days | ICC = 0.591 | - | SEM = 0.505 | ? |
Outcome Measurement Instrument | Author and year | Construct validity | Responsiveness | ||||
---|---|---|---|---|---|---|---|
Study population | Cosmin Rate | Statistical Results | Measurement property ratings based on statistical results | Cosmin Rate | Measurement property ratings based on statistical results | ||
Strain elastography | Ooi et al., 2015 [27] | 120 control120 with AT | Very good | ultrasonography vs strain ratio spearman = 0.81 strain ratio vs VISA-A r = -0.62, p < 0.001 | + | NA | NA |
Yamamoto et al., 2016 [34] | 50 bilateral | Very good | No significant difference between age groups except for the 30age group | - | Very good | + | |
Schneebeli et al., 2019 [36] | 37 bilateral | Very good | Friedman test p < 0.01 significant difference | + | NA | NA | |
Schneebeli et al., 2021 [37] | 20 bilateral | Very good | Friedman test p < 0.01 significant difference | + | NA | NA | |
Shear wave elastography—velocity | Aubry et al., 2013 [38] | 80 bilateral | Adequate | Univariate analysis | + | NA | NA |
DeWall et al., 2014 [39] | 10 | Adequate | Three-way ANOVA for posture, path & region | + | NA | NA | |
Aubry et al., 2015 [28] | 30 pathological, 180 healthy | Adequate | Normal had significantly lower mean velocity than AT axial SW for plantarflexion (P < .001), at sagittal SW for 0° (P = .001), and at axial SW for 0° (P = .0026) | + | NA | NA | |
Fu et al., 2016 [40] | 326 bilateral | Adequate | Pearson—no significant correlation of SW velocity with age | - | NA | NA | |
Dirrichs et al., 2016 [29] | 41 bilateral | Adequate | SW velocity correlates to VISA-A | + | NA | NA | |
Coombes et al., 2018 [30] | 50 right or left, healthy and AT | Adequate | AT lower SW velocity at insertion (P < .001), but not mid-tendon region (P = .456) | + | NA | NA | |
Shear wave elastography—modulus | Helfenstein-Didier et al., 2016 [41] | 10 right | Adequate | Pearson = 0.844 SW elastography to dispersion analysis confirming the guided wave propagation | + | NA | NA |
Lima et al., 2017 [42] | 24 healthy- bilateral | Adequate | Pearson = 0.00–0.041 no correlation to isometric contraction | - | NA | NA | |
Schneebeli et al., 2021 [37] | 20 bilateral | Very good | Friedman test p < 0.05 | - | NA | NA | |
Gatz et al., 2021 [31] | 75 | Adequate | Diagnostic—No significant difference (P = .062-.994) in favour one modality | + | Very good | ||
cSWE | Suydam et al., 2015 [44] | 29 bilateral | Adequate | Pearson < 0.12 between shear modulus and MVIC | - | NA | NA |
Corrigan et al., 2019 [45] | 6 right | Adequate | Pearson s = 0.992, p = 0.008, v = 0.994, p = 0.006, d = 0.997, p = 0.003 | + | NA | NA |
Best evidence synthesis
Reliability | Summary or pooled ICC result | Overall rating of good measurement properties | Quality of evidence | |
---|---|---|---|---|
Strain elastography | Intra rater same day | Total sample size—176 | Sufficient | Moderate (downgraded for inconsistency) |
Longitudinal > 0.7 | ||||
Total sample size—58 | Sufficient | Moderate (downgraded for imprecision sample size < 100) | ||
Transverse < 0.45 | ||||
Intra rater different days | Total sample size—20 | Insufficient | / | |
Longitudinal > 0.1–0.87 | ||||
Transverse > 0.1 | ||||
Inter-rater | Total sample size—110 | Sufficient | Moderate (downgraded for inconsistency) | |
Longitudinal = 0.51–0.79 | ||||
Assessed in one article | Insufficient | / | ||
Total sample size—50 | ||||
Transverse = 0.41 | ||||
Shear wave velocity | Intra rater same day | Assessed in one article | / | |
Total sample size—14 | ||||
Longitudinal = 0.55–0.67 | Insufficient | |||
Transverse = 0.78–0.85 | Insufficient | |||
Intra rater different days | Total sample size—36 | Sufficient | Very Low (downgraded 2 for imprecision sample size < 50 & inconsistency) | |
Longitudinal = 0.54–0.71 | ||||
Assessed in one article | Insufficient | / | ||
Total sample size—14 | ||||
transverse = 0.62–0.71 | ||||
Inter-rater | Total sample size—665 | Sufficient | Moderate (downgraded for inconsistency) | |
Longitudinal = 0.455–0.923 | ||||
Total sample size—655 | Sufficient | Moderate (downgraded for indirectness) | ||
Transverse = 0.7–0.87 | ||||
Shear wave modulus | Intra rater same day | Assessed in one article | Insufficient | / |
Total sample size—7 | ||||
Compression modulus = 0.42–0.85 | ||||
Intra rater different days | Assessed in one article | Insufficient | / | |
Total sample size—20 | ||||
Shear modulus = 0.82–0.88 | ||||
Inter-rater | Assessed in one article | Insufficient | / | |
Total sample size—20 | ||||
Shear modulus = 0.77–0.93 | ||||
cSWE | Intra rater same day | Total sample size—78 | Sufficient | Low (downgraded for imprecision sample size < 100 and indirectness) |
shear modulus = 0.7–0.88 | ||||
viscosity modulus = 0.87–0.88 | ||||
Intra rater different days | Assessed in one article | Insufficient | / | |
Total sample size—20 | ||||
shear modulus = 0.7 | ||||
viscosity modulus = 0.87 | ||||
3D SWE | Intra rater different days | Assessed in one article | Insufficient | / |
Total sample size—10 | ||||
0.59 | ||||
Inter-rater | Assessed in one article | Insufficient | / | |
Total sample size—10 | ||||
0.44 |
Validity | Summary or pooled result | Overall rating of good measurement properties | Quality of evidence | |
---|---|---|---|---|
Strain elastography | Convergent | Assessed in one article | Insufficient | / |
Correlated to VISA-A for symptomatic AT | ||||
Total sample size—240 | ||||
Assessed in one article | Insufficient | / | ||
Correlated to B mode US | ||||
Total sample size—240 | ||||
Correlated to isometric contractions | Sufficient | Moderate (downgraded for indirectness) | ||
Total sample size—114 | ||||
Discriminative | Assessed in one article | Insufficient | / | |
Age | ||||
Total sample size 100 | ||||
Gender | Sufficient | Moderate (downgraded for indirectness) | ||
Total sample size—114 | ||||
Shear wave velocity | Convergent | Correlated to VISA-A for symptomatic AT | Sufficient | High |
Total sample size—207 | ||||
Discriminative | age | Sufficient | High | |
Total sample size—702 | ||||
Assessed in one article | Insufficient | / | ||
Gender | ||||
Total sample size—652 | ||||
Tendinopathy | Sufficient | Moderate (downgraded for inconsistency) | ||
Total sample size—342 | ||||
Foot posture—increases with dorsiflexion | Sufficient | High | ||
Total sample size—370 | ||||
Assessed in one article | Insufficient | / | ||
BMI | ||||
Total sample size—50 | ||||
Shear wave modulus | Criterion | Assessed in one article | Insufficient | / |
Correlated to MRI, US, doppler flow & UTC | ||||
Total sample size—75 | ||||
Convergent | Assessed in one article | Insufficient | / | |
correlated to dispersion analysis | ||||
Total sample size—10 | ||||
Correlated to isometric contraction | Sufficient | Low (downgraded for imprecision sample size & indirectness) | ||
Total sample size—88 | ||||
cSWE | Convergent | correlation to MVIC | Sufficient | Very Low (downgraded for imprecision sample size < 100 & inconsistency & indirectness) |
Total sample size—58 | ||||
Pearson CC = < 0.12–0.99 | ||||
Assessed in one article | Insufficient | / | ||
Correlation to shear wave modulus | ||||
Total sample size—6 |
Measurement error | Summary or pooled result | Overall rating | Quality of evidence |
---|---|---|---|
Strain elastography | No MIC reported | Indeterminate | / |
Total sample size—108 | |||
Shear wave velocity | No MIC reported | Indeterminate | / |
Total sample size—24 | |||
Shear wave modulus | SEM = 11.87–21.75 kPa | Indeterminate | / |
Total sample size—27 | |||
cSWV | SEM s = 3.8–8.28 kPa v = 4.79–6.8Pas d = 46.72 kPa | Indeterminate | / |
Total sample size—78 | |||
3D SWV | Assessed in one article | Insufficient | / |
Total sample size—108 |