search for



The Results of the Ultrasonographic Evaluation for the Contralateral Achilles Tendon in Patients with Acute Achilles Tendon Rupture
Korean J Sports Med 2023;41:147-152
Published online September 1, 2023;  https://doi.org/10.5763/kjsm.2023.41.3.147
© 2023 The Korean Society of Sports Medicine.

Dae-Geun Kim1, Jun-Beom Kim2, Byeong-Seop Park2

1Department of Sports, Daejeon University, Daejeon, 2WellBone Orthopedic Hospital, Daejeon, Korea
Correspondence to: Jun-Beom Kim
WellBone Orthopedic Hospital, 23-24 Gwanjeobuk-ro 13beongil, Seo-gu, Daejeon 35363, Korea
Tel: +82-42-710-7579, Fax: +82-42-710-7580, E-mail: kjb9290@gmail.com
Received March 31, 2023; Revised July 24, 2023; Accepted July 26, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: This study was performed to evaluate changes in Achilles tendon (AT) characteristics of asymptomatic tendons in patients with acute AT ruptures on the contralateral side by using ultrasonography.
Methods: From January 2016 to December 2018, 31 patients were enrolled. The contralateral asymptomatic ATs were assessed: (1) fluid collection of paratenon, (2) echogenicity, and (3) thickness. The ATs were divided into the distal, middle, and proximal thirds for evaluation and were assessed before the surgery, as well as at 6 weeks, 3 months, 6 months, and 12 months after the surgery. At each time, pain in the tendons was recorded.
Results: In all cases, it was observed that there was a hypoechoic lesion or fluid collection of the paratenon, which did not show a significant change over time. There was no significant difference in tendon thickness according to the period in the distal and proximal areas, and significant differences were observed only in the middle area (p<0.05). A new pain around the tendon occurred most often at 6 weeks after surgery (eight cases of 31 cases, 25.8%). Eight cases of pain (47.1%) remained at 12 months after surgery.
Conclusion: In patients with acute AT rupture, ultrasonographic hypoechoic lesions or fluid collections of the paratenon were initially observed on the contralateral tendon, but this did not show significant changes over time. A significant change in tendon thickness was observed in the middle area, but this did not show a close association with pain.
Keywords : Ankle, Achilles tendon, Rupture, Tendinopathy, Ultrasonography
꽌 濡

븘궗젅뒪嫄댁 떊泥댁뿉꽌 媛옣 몢猿띻퀬 媛뺥븳 嫄댁쑝濡, 媛옄誘멸렐怨 鍮꾨났洹쇱쓽 嫄대쭑뿉꽌 떆옉빐꽌 醫낃낏쓽 썑硫 룎湲곗쓽 媛슫뜲 遺쐞뿉 遺李⑺븳떎. 븘궗젅뒪嫄댁 꽭 愿젅쓣 嫄몄튂뒗 洹쇨굔 쑀湲곗껜쓽 븳 遺遺꾩쑝濡, 臾대쫷 諛 議깃젅쓽 援닿끝怨 嫄곌낏븯 愿젅쓽 궡踰 옉슜뿉 愿뿬븯뒗 援ъ“臾쇱씠떎1. 理쒓렐뿉뒗 痍⑤ 솢룞 諛 뿬媛 떆媛꾩쓽 利앷濡 씤빐 湲됱꽦 뒪룷痢 넀긽怨 怨쇱궗슜쑝濡 씤븳 넀긽쓽 鍮덈룄媛 利앷븯뒗 異붿꽭씠떎2. 븘궗젅뒪嫄댁 씤泥댁뿉꽌 媛옣 옄二 넀긽 諛쏅뒗 嫄 以 븯굹濡, 뙆뿴쓽 鍮덈룄뒗 利앷븯뒗 異붿꽭씠떎. 뙆뿴쓽 썝씤 궡쟻 슂씤怨 쇅쟻 슂씤씠 蹂듯빀쟻쑝濡 옉슜븯吏留, 洹 썝씤씠 紐낇솗엳 븣젮졇 엳吏 븡떎3-5.

븯吏留, 씠쟾뿉 븘궗젅뒪嫄 뙆뿴쓣 寃쏀뿕븳 궗엺뱾뿉寃뚯꽌 諛섎履 嫄댁쓽 뙆뿴 鍮덈룄媛 利앷븳떎뒗 臾명뿄 蹂닿퀬媛 엳떎6. 嫄댁씠 뙆뿴맂 솚옄뱾濡쒕꽣 梨꾩랬븳 뙆뿴 嫄 議곗쭅뿉꽌 궛냼꽦 눜뻾꽦 嫄 蹂묐(tendinopathy), 왋븸 蹂꽦(mucoid degeneration), 嫄댁쓽 吏諛⑹쥌利(tendolipomatosis), 洹몃━怨 꽍쉶꽦 嫄 蹂묐怨 媛숈 깮泥댁뿭븰쟻 꽦吏 蹂솕媛 愿李곕릺뿀怨, 씠윭븳 議곗쭅蹂묐━쟻 蹂솕濡 븘궗젅뒪嫄댁쓽 臾쇰━쟻 꽦吏덉씠 蹂솕븷 닔 엳떎怨 븯떎3. 씠뿉 옄뱾 넀긽 遺쐞쓽 諛섎履 嫄댁뿉 떆媛꾩쓽 쓲由꾩뿉 뵲씪 怨쇱궗슜쑝濡 씤븳 臾쇱쭏쟻 蹂솕媛 엳쓣 寃껋쑝濡 媛젙븯怨, 씠윭븳 蹂솕瑜 솗씤븯湲 쐞빐 洹쇨낏寃⑷퀎 珥덉쓬뙆(ultrasonography) 湲곌퀎瑜 궗슜븯뿬 蹂솕瑜 愿李고븯湲곕줈 븯떎.

珥덉쓬뙆뒗 븘궗젅뒪嫄댁쓽 鍮꾩젙긽 蹂묐쓣 룊媛븯뒗 뜲 슚怨쇱쟻씠怨 젙솗븳 諛⑸쾿쑝濡 씠誘 꼸由 븣젮졇 엳떎7,8. 젙긽 嫄댁 떆긽硫댁뿉꽌 吏곸꽑쓽 怨좎뿉肄붿꽦 꽟쑀吏덇낵 洹좎씪븳 몢猿섎 蹂댁씠怨, 슒떒硫댁뿉꽌뒗 삤紐⑺븯嫄곕굹 렪룊븳 嫄댁쓽 쟾硫대媛 愿李곕맂떎9. 理쒓렐 옱寃넗 뿰援щ낫怨좎뿉 뵲瑜대㈃, 嫄 蹂묐━瑜 痢≪젙븯湲 쐞븳 留ㅺ컻 蹂닔뱾(parameters)濡 嫄댁쓽 몢猿, 뿉肄붿꽦, 洹몃━怨 삁愿 遺꾪룷瑜 룷븿빐빞 븳떎怨 븯怨10, 珥덉쓬뙆 쁺긽 嫄 蹂묐쓽 遺꾨쪟 移섎즺 諛⑸쾿 寃곗젙뿉 븘슂븳 異붽쟻씤 젙蹂대 뼸湲곗뿉 쑀슜븯떎怨 븯떎11.

넀긽맂 嫄, 삉뒗 넀긽맂 嫄댁쓽 諛섎履쎄낵 젙긽 嫄댁쓣 鍮꾧탳븳 臾명뿄뱾 蹂닿퀬맂 諛 엳吏留12,13, 넀긽맂 嫄댁쓽 諛섎履 嫄댁뿉 빐꽌 떆媛꾩뿉 뵲瑜 蹂솕瑜 愿李고븳 蹂닿퀬뒗 븘吏 뾾뒗 떎젙씠떎. 蹂 뿰援ъ쓽 紐⑹쟻 珥덉쓬뙆瑜 궗슜븯뿬 湲됱꽦 븘궗젅뒪嫄 뙆뿴 솚옄뱾쓽 諛섎痢 嫄댁뿉꽌쓽 湲곌컙뿉 뵲瑜 蹂솕瑜 븣븘蹂닿퀬, 넻利앷낵 媛숈 엫긽쟻 蹂솕瑜 媛숈씠 븣븘蹂닿퀬옄 븿뿉 엳떎. 옄뱾쓽 媛꽕 諛섎履 嫄댁쓽 臾쇰━쟻 蹂솕媛 떆媛꾩씠 吏궓뿉 뵲씪 諛쒖깮븳떎뒗 寃껋씠떎.

뿰援 諛⑸쾿

1. 뿰援 긽

2016뀈 1썡遺꽣 2018뀈 12썡源뚯 湲됱꽦 븘궗젅뒪嫄 뙆뿴濡 닔닠 移섎즺瑜 諛쏄퀬 12媛쒖썡媛 異붿떆媛 媛뒫뻽뜕 31紐낆쓣 긽쑝濡 븯떎. 紐⑤뱺 긽옄뿉寃 뿰援ъ쓽 紐⑹쟻怨 젅李⑥뿉 빐 꽕紐낇븯怨, 궗쟾 룞쓽瑜 諛쏆 썑뿉 뿰援щ 吏꾪뻾븯떎. 닔닠諛쏆 븡 諛섎履 嫄댁쓣 긽쑝濡 珥덉쓬뙆 寃궗瑜 떆뻾뻽쑝硫, 紐⑤몢 궓꽦쑝濡 룊洹 뿰졊 39.8꽭(踰붿쐞, 25–48꽭), 룊洹 泥댁쭏웾吏닔뒗 25.7±2.6 kg/m2씠뿀떎. 紐⑤뱺 솚옄뿉꽌 嫄댁쓽 鍮꾩젙긽 냼寃ш낵 愿젴씠 엳떎怨 븣젮吏 瑜섎쭏떚뒪 愿젅뿼(rheumatoid arthritis), 泥숈텛 愿젅利(spondyloarthropathy), 삉뒗 怨좎퐳젅뒪뀒濡ㅽ삁利(hypercholesterolemia)怨 媛숈 쟾떊꽦 뿼利 吏덊솚쓣 솗씤븯怨 諛곗젣븯떎14. 蹂 뿰援ъ뿉 룷븿맂 솚옄뱾 紐⑤몢 쓬꽦씠뿀떎.

嫄댁쓽 셿쟾 뙆뿴 遺쐞뒗 쇊履쎌씠 17삁, 삤瑜몄そ씠 14삁떎. 紐⑤뱺 삁뿉꽌, 뙆뿴 遺쐞뒗 嫄댁쓽 以묎컙 遺쐞怨 媛쒕갑꽦 닠떇쓣 씠슜븯뿬 닔닠쓣 떆뻾븯떎. 닔닠 以 諛 닔닠 썑 빀蹂묒쬆 뾾뿀怨, 옱뙆뿴쓽 삁뒗 뾾뿀떎.

2. 옱솢 移섎즺

닔닠 썑, 닔닠 遺쐞 떎由щ뒗 빟 6二 룞븞 떒븯吏 꽍怨 怨좎젙쓣 븯怨, 6二쇱㎏ 꽍怨 怨좎젙씠 90° (neutral position)媛 媛뒫븯룄濡 留ㅼ< 떎떆 꽍怨 怨좎젙쓣 븯떎. 닔닠 썑 6二쇱㎏ 꽍怨 怨좎젙쓣 젣嫄고븳 썑, 蹂댁“湲(Camwalker boots, VTS One Member Co., Ltd.)瑜 李⑹슜븯怨 諛쒕ぉ 媛곷룄 슫룞 諛 洹쇰젰 媛뺥솕 슫룞쓣 떆옉븯떎. 씠 떆젏뿉꽌 遺遺 泥댁쨷 遺븯瑜 뿀슜븯떎.

닔닠 썑 8二쇱㎏ 쟾 泥댁쨷 遺븯瑜 뿀슜븯怨, 洹쇰젰슫룞쓣 吏냽븯떎. 닔닠 썑 6媛쒖썡 씠궡뿉 떖由ш린 벑 媛踰쇱슫 슫룞 媛뒫븯떎.

3. 쁺긽 寃궗

諛섎履 븘궗젅뒪嫄대뱾 紐⑤몢 珥덉쓬뙆(Acuson X300, 11.4 MHz; Siemens Healthineers)瑜 씠슜븯뿬 떎쓬怨 媛숈 빆紐⑹쓣 룊媛븯떎. (1) 옒以꾩쁿議곗쭅(paratenonitis) 二쇰쓽 鍮꾩젙긽 泥댁븸 瑜 쁽긽(fluid collection of periparatenon), (2) 뿉肄붿꽦(echogenicity, fibrillar echotexture), (3) 몢猿(thickness).

珥덉쓬뙆 寃궗뒗 洹쇨낏寃⑷퀎 珥덉쓬뙆뿉 寃쏀뿕씠 留롮 븳 紐낆쓽 寃궗옄媛 吏꾪뻾뻽怨, 솚옄뒗 寃궗 梨낆긽뿉 蹂듭쐞(prone position)옄꽭濡 닏怨 諛쒕ぉ 以묐┰ 긽깭(90° 援닿끝)瑜 쑀吏븯寃 븯떎. 嫄댁쓽 몢猿섎뒗 궡怨 썑硫댁뿉꽌 떆긽硫댁쑝濡 蹂댁씠뒗 嫄댁쓽 븵뮘 嫄곕━濡 痢≪젙븯怨, 嫄댁쓽 뿉肄붿꽦씠굹 옒以꾩뿼議곗쭅 二쇰쓽 鍮꾩젙긽 泥댁븸 瑜 쁽긽쓣 솗씤븯怨 湲곕줉븯떎. 珥덉쓬뙆 蹂솚湲(transducer)뒗 꽑긽 삎깭(linear type)瑜 궗슜븯怨 鍮꾨벑諛⑹꽦(anisotropy)쓣 뵾븯湲 쐞빐 嫄닿낵 닔吏곸씠 릺룄濡 쐞移섑븯떎. 珥덉쓬뙆 寃궗뒗 媛숈 遺쐞瑜 2踰 씠긽 痢≪젙븯뿬 諛섎났븯떎. 紐⑤뱺 쁺긽 옣븯뿬 異뷀썑 넻怨꾩쟻 룊媛뿉 궗슜븯떎.

븘궗젅뒪嫄댁 紐⑤몢 꽭 遺쐞(썝쐞遺, 以묎컙遺쐞, 洹쇱쐞遺)濡 굹늻뼱꽌 愿李고븯떎. 썝쐞遺뒗 醫낃낏쓽 遺李 遺쐞 二쇰, 以묎컙 遺쐞뒗 醫낃낏 遺李 遺쐞뿉꽌 긽諛⑹쑝濡 4 cm, 洹쇱쐞遺뒗 洹쇨굔 젒빀 遺쐞濡 젙쓽븯떎15. 洹몃━怨, 嫄댁뿉 븳 룊媛뒗 媛곴컖 닔닠 쟾 궡썝씪, 닔닠 썑 6二, 3媛쒖썡, 6媛쒖썡, 12媛쒖썡吏몄뿉 吏꾪뻾븯떎.

4. 옄猷 遺꾩꽍

寃궗쓽 떦룄(validity)瑜 넂씠湲 쐞빐꽌 옣맂 쁺긽쓣 1二쇱씪 媛꾧꺽쑝濡 2踰 愿李고븯뿬 룊媛븯怨 룊洹좉컪쓣 湲곕줉븯떎. 湲곌컙뿉 뵲씪 嫄댁쓽 3遺쐞뿉꽌 몢猿, 뿉肄붿꽦 蹂묐 삉뒗 鍮꾩젙긽 泥댁븸 瑜 쁽긽쓽 쑀臾대 湲곕줉븯怨 蹂솕瑜 愿李고븯떎. 삉븳, 湲곌컙蹂 嫄 二쇱쐞 넻利 쑀臾대 吏덈Ц븯怨 떟蹂쓣 湲곕줉븯떎.

嫄 궡遺뿉 뿉肄붿꽦 蹂묐(hypoechoic lesion, heterogenous)씠 愿李곕릺뒗 寃쎌슦뒗 嫄 蹂묒쬆(tendinosis)쑝濡, 泥댁븸 瑜 삉뒗 嫄댁쓽 쇅痢〓뿉 뿉肄붿꽦 蹂묐씠 愿李곕릺뒗 寃쎌슦뒗 옒以꾩쁿議곗쭅뿼쑝濡 젙쓽븯怨 湲곕줉븯떎.

5. 넻怨 遺꾩꽍

닔吏묐맂 옄猷뚮뒗 IBM SPSS version 20 (IBM Corp.)瑜 씠슜븯뿬 넻怨꾩쟻쑝濡 遺꾩꽍븯떎. 닽옄 蹂닔뱾 룊洹좉낵 몴以렪李⑤줈 몴떆뻽쑝硫, 媛믩뱾쓽 寃利 諛 긽愿 愿怨꾨 븣븘蹂닿린 쐞빐꽌 Kolmogorov-Smirnov test, 떎以 꽑삎 쉶洹 遺꾩꽍, t-test瑜 궗슜븯떎. p媛믪 0.05 誘몃쭔씤 寃쎌슦뿉 넻怨꾩쟻쑝濡 쓽誘멸 엳떎怨 젙쓽븯떎.

寃 怨

닔닠 쟾, 紐⑤뱺 솚옄뱾쓽 諛섎痢 嫄댁뿉꽌 鍮꾩젙긽쟻 珥덉쓬뙆 냼寃ъ씠 愿李곕릺뿀떎. 紐⑤몢 嫄댁쓽 以묎컙遺쐞뿉꽌 愿李곕릺뿀쑝硫, 鍮꾩젙긽 泥댁븸 瑜 쁽긽, 뿉肄붿꽦 蹂묐, 삉뒗 몢 蹂묐씠 媛숈씠 엳뒗 寃쎌슦媛 愿李곕릺뿀떎(Fig. 1). 옒以꾩쁿議곗쭅뿼(paratenonitis, homogenous) 21삁(67.7%), 嫄 蹂묒쬆(tendinosis, heterogenous)뒗 7삁(22.6%), 몢 蹂묐씠 紐⑤몢 엳뒗 寃쎌슦뒗 3삁(9.7%)쑝硫, 珥덇린뿉 愿李곕맂 嫄 蹂묐 떆媛꾩씠 吏궓뿉 뵲씪 겙 蹂솕瑜 蹂댁씠吏 븡븯떎. 닔닠 씠쟾 諛섎履 嫄 遺쐞뿉 넻利앹쓣 뒓瑗덈뜕 삁뒗 31삁 以 6삁(19.4%)쑝硫, 씠 以 2삁뒗 옒以꾩쁿議곗쭅뿼, 3삁뒗 嫄 蹂묒쬆, 1삁뒗 옒以꾩쁿議곗쭅뿼怨 嫄 蹂묒쬆씠 룞諛섎맂 냼寃ъ씠뿀떎.

Fig. 1. (A) Paratendinopathy. Linear hypoechoic lesion of the outer tendon, at middle portion of the tendon. (B) Tendinosis. Hypoechoic lesion in the tendon, at middle portion of the tendon. (C) Paratendinopathy and tendinosis. Mild thickened tendon with diffuse hypoechogenecity, at middle portion of the tendon.

깉濡寃 嫄 遺쐞 넻利앹씠 諛쒖깮븳 寃쎌슦뒗 31삁 以 17삁(54.8%)媛 愿李곕릺뿀떎. 닔닠 썑 6二쇱㎏ 깉濡寃 넻利앹씠 諛쒖깮븳 寃쎌슦뒗 珥 8삁쑝硫, 4삁뒗 옒以꾩쁿議곗쭅뿼, 2삁뒗 嫄 蹂묒쬆, 2삁뒗 옒以꾩쁿議곗쭅뿼怨 嫄 蹂묒쬆쓽 룞諛섏냼寃ъ씠 愿李곕릺뿀吏留, 紐⑤몢 씠쟾 蹂묐怨 겙 蹂솕瑜 蹂댁씠吏뒗 븡븯떎. 닔닠 썑 3媛쒖썡吏 깉濡寃 넻利앹씠 諛쒖깮븳 寃쎌슦뒗 珥 4삁쑝硫, 3삁뒗 옒以꾩쁿議곗쭅뿼, 1삁뒗 嫄 蹂묒쬆쑝濡 紐⑤몢 씠쟾 蹂묐怨 겙 蹂솕瑜 蹂댁씠吏뒗 븡븯떎. 닔닠 썑 6媛쒖썡吏 깉濡寃 넻利앹씠 諛쒖깮븳 寃쎌슦뒗 珥 4삁쑝硫, 紐⑤뱺 삁뿉꽌 옒以꾩쁿議곗쭅뿼 냼寃ъ씠 愿李곕릺뿀떎. 닔닠 썑 12媛쒖썡吏 깉濡寃 넻利앹씠 諛쒖깮븳 寃쎌슦뒗 珥 1삁쑝硫, 珥덉쓬뙆 寃궗뿉꽌 옒以꾩쁿議곗쭅뿼 냼寃ъ씠 愿李곕릺뿀떎. 理쒖쥌 異붿떆 12媛쒖썡吏 넻利앹쓣 샇냼븯뒗 寃쎌슦뒗 17삁 以 珥 8삁(47.1%)濡, 珥덉쓬뙆 냼寃ъ쓽 蹂솕瑜 蹂댁씤 寃쎌슦뒗 3삁씠硫, 紐⑤몢 뿉肄 蹂묐씠 利앷맂 냼寃ъ씠 愿李곕릺뿀떎. 븯吏留, 珥덉쓬뙆 蹂묐쓽 蹂솕 넻利 諛쒖깮 뿬遺뒗 넻怨꾩쟻 쑀쓽꽦쓣 蹂댁씠吏 븡븯떎(p>0.05).

썝쐞 遺쐞쓽 嫄 몢猿섎뒗 珥덇린뿉뒗 3.89±0.43 mm, 닔닠 썑 6二쇱뿉뒗 3.92±0.41 mm, 닔닠 썑 3媛쒖썡뿉뒗 3.91±0.52 mm, 닔닠 썑 6媛쒖썡뿉뒗 3.86±0.49 mm, 닔닠 썑 12媛쒖썡뿉뒗 3.83±0.44 mm吏留, 넻怨꾩쟻쑝濡 쓽誘 엳뒗 蹂솕뒗 뾾뿀떎(p>0.05). 洹쇱쐞 遺쐞쓽 嫄 몢猿섎뒗 珥덇린뿉뒗 4.25±0.78 mm, 닔닠 썑 6二쇱뿉뒗 4.23±0.55 mm, 닔닠 썑 3媛쒖썡뿉뒗 4.14±0.59 mm, 닔닠 썑 6媛쒖썡뿉뒗 4.16±0.69 mm, 닔닠 썑 12媛쒖썡뿉뒗 4.15±0.62 mm吏留, 넻怨꾩쟻쑝濡 쓽誘 엳뒗 蹂솕뒗 뾾뿀떎(p>0.05). 以묎컙 遺쐞쓽 嫄 몢猿섎뒗 珥덇린뿉뒗 4.79± 0.57 mm, 닔닠 썑 6二쇱뿉뒗 4.72±0.49 mm, 닔닠 썑 3媛쒖썡뿉뒗 4.83±0.56 mm, 닔닠 썑 6媛쒖썡뿉뒗 4.92±0.58 mm, 닔닠 썑 12媛쒖썡뿉뒗 4.97±0.57 mm怨, 넻怨꾩쟻쑝濡 쓽誘 엳뒗 蹂솕뒗 珥덇린 닔닠 썑 12媛쒖썡媛, 닔닠 썑 6二쇱 6媛쒖썡媛, 닔닠 썑 6二쇱 12媛쒖썡媛, 닔닠 썑 3媛쒖썡怨 6媛쒖썡媛, 닔닠 썑 6媛쒖썡怨 12媛쒖썡媛 궗씠뿉 愿李곕릺뿀떎(p<0.05) (Tables 1 and 2).

Table 1 . The thickness of the tendons, follow as portions and periods

PeriodThickness (mm)
Distal portionMiddle portionProximal portion
Before the surgery3.98±0.434.79±0.574.25±0.78
6 Weeks3.92±0.414.72±0.494.23±0.55
3 Months3.91±0.524.83±0.564.14±0.59
6 Months3.86±0.494.92±0.584.16±0.69
12 Months3.83±0.444.97±0.574.15±0.62

Values are presented as mean±standard deviation.



Table 2 . The p-values of the thickness

Comparing the periods p-value
Distal portionMiddle portionProximal portion
1 vs. 20.5420.3530.758
1 vs. 30.7130.6050.161
1 vs. 40.7050.1060.259
1 vs. 50.3000.0230.185
2 vs. 30.9250.1300.133
2 vs. 40.3860.0160.382
2 vs. 50.1110.0020.240
3 vs. 40.4140.0380.605
3 vs. 50.1620.0040.808
4 vs. 50.3950.1570.704

1: before the surgery, 2: 6 weeks after surgery, 3: 3 months after surgery, 4: 6 months after surgery, 5: 12 months after surgery.

p-value of less than 0.05 was accepted as statistically significant (paired t-test).


怨 李

븘궗젅뒪嫄댁 씤泥댁뿉꽌 媛옣 媛뺥븯怨 몢爰쇱슫 嫄댁쑝濡 肄쒕씪寃 1삎(type I collagen)쓽 룊뻾븳 꽟쑀吏덈줈 援ъ꽦릺뼱 엳怨, 씠뒗 젣3삎 肄쒕씪寃먮낫떎 뜑 媛뺥븯硫 쑀뿰븯떎怨 븣젮졇 엳떎16. 븯吏留 嫄 蹂묐씠 엳뒗 寃쎌슦뿉뒗 뵳뵳븯怨 鍮꾧퇏吏덉꽦쓽 꽟쑀 援ъ“媛 愿李곕맂떎怨 븯怨, 씠뒗 肄쒕씪寃먯쓽 蹂꽦씠 嫄 꽟쑀吏덉쓽 援ъ“臾쇱쓣 넀긽떆궎뒗 뜲 썝씤씠 엳떎怨 븯떎12,16. Tan 벑12 珥덉쓬뙆 寃궗뿉꽌 嫄닿컯븳 嫄댁뿉꽌뒗 嫄댁쓽 뼱뒓 怨녹뿉꽌룄 鍮꾧퇏吏덉꽦쓽 援ъ“臾쇱쓣 愿李고븷 닔 뾾뿀떎怨 븯떎. 떎瑜 蹂닿퀬뿉 뵲瑜대㈃ 눜뻾꽦 嫄 蹂묒쬆뿉꽌뒗 嫄 援ъ“媛 蹂븷 닔 엳뒗 뒫젰씠 嫄곗쓽 뾾쑝硫, 嫄 援ъ“媛 엫긽 寃곌낵 愿젴씠 뾾떎怨 븯떎15. 蹂 뿰援ъ뿉꽌뒗 31삁 以 10삁(32.3%)뿉꽌 珥덇린뿉 鍮꾧퇏吏덉꽦쓽 꽟쑀 援ъ“瑜 珥덉쓬뙆瑜 넻빐꽌 솗씤븯怨, 씠 以 4삁뿉꽌留 嫄 二쇱쐞 넻利앹쓣 샇냼븯뿬, 꽟쑀 援ъ“ 蹂솕 넻利앹쓽 쑀臾대뒗 빆긽 씪移섑븯吏뒗 븡븯떎뒗 젏쓣 솗씤븯떎. 삉븳, 꽟쑀 援ъ“쓽 蹂솕뒗 떆媛꾩씠 吏궓뿉 뵲씪 愿李곕릺뒗 넻利 쑀臾댁쓽 蹂솕룄 뿰愿꽦쓣 蹂댁씠吏 븡븯떎. 넻利앹뿉 빐꽌 빟臾 벑쓽 蹂댁〈쟻 移섎즺瑜 떆뻾븯怨, 닔닠 遺쐞 嫄 媛뺥솕 슫룞쑝濡 諛섎履 嫄댁쓽 遺븯瑜 以꾩뿬二쇰뒗 移섎즺瑜 蹂묓뻾븯떎.

留롮 뿰援ъ뿉꽌 븘궗젅뒪嫄댁쓽 以묎컙 遺쐞媛 넀긽 諛쏄린 媛옣 돩슫 怨녹씠씪怨 蹂닿퀬븯怨 엳怨, 諛섎났쟻씤 遺븯뿉 留뚯꽦쟻쑝濡 끂異쒕맂 嫄대뱾 떒硫댁쟻쑝濡 솗옣맂 냼寃ъ쓣 蹂댁씪 닔 엳떎怨 븯떎17,18. Li 벑13 씠쟾뿉 嫄 뙆뿴쓣 寃쏀뿕븳 臾댁쬆긽쓽 諛섎履 嫄댁씠 嫄닿컯븳 議곌뎔뿉 鍮꾪빐 以묎컙 遺쐞 썝쐞 遺쐞뿉꽌 뜑 몢猿띻퀬, 겕怨 뫁湲떎뒗 寃곌낵瑜 蹂닿퀬븯怨, 嫄 뙆뿴씠 삁긽릺뒗 珥덇린 蹂묐쓣 愿李고븯뒗 뜲 깂꽦珥덉쓬뙆(sonoelastography)媛 쑀슜븯떎怨 蹂닿퀬븯떎.

蹂 뿰援ъ쓽 紐⑹쟻 嫄 뙆뿴 솚옄뿉꽌 利앹긽쓽 쑀臾댁 긽愿뾾씠 떆媛꾩뿉 뵲瑜 諛섎痢 嫄댁쓽 긽깭 蹂솕瑜 씪諛 珥덉쓬뙆瑜 씠슜븯뿬 愿李고븯뒗 寃껋뿉 엳떎. 옒以꾩쁿議곗쭅뿼쓽 湲됱꽦湲 珥덉쓬뙆 냼寃ъ 嫄 二쇰쑝濡 鍮꾩젙긽 泥댁븸 瑜 삉뒗 嫄 쇅痢〓쓽 쓬쁺 媛먯냼瑜 愿李고븷 닔 엳怨, 嫄 蹂묒쬆쓽 寃쎌슦뿉뒗 嫄 궡뿉 뿉肄붿꽦 蹂묐씠 愿李곕릺뒗뜲 씠뒗 嫄 궡 꽍쉶솕 蹂묐쓣 룞諛섑븷 닔룄 엳怨 怨꾩냽 吏꾪뻾맆 寃쎌슦 嫄댁씠 몢爰쇱썙吏꾨떎怨 븯떎1,19,20. 뿰援 寃곌낵, 諛섎履 嫄댁쓽 紐⑤뱺 遺쐞뿉꽌 옒以꾩쁿議곗쭅뿼 삉뒗 嫄 蹂묒쬆쓽 珥덉쓬뙆 냼寃ъ씠 엳뿀吏留, 떆媛꾩쓽 蹂솕뿉 뵲瑜 넻怨꾩쟻 쑀쓽꽦 愿李곕릺吏 븡븯떎. 嫄댁쓽 긽깭 蹂솕 以, 떆媛꾩뿉 뵲瑜 嫄 몢猿섏쓽 蹂솕留뚯씠 以묎컙 遺쐞뿉꽌留 쓽誘 엳寃 愿李고븷 닔 엳뿀怨, 3媛쒖썡 씠긽 媛꾧꺽쓣 몢뿀쓣 븣留 쓽誘 엳뒗 몢猿 蹂솕瑜 愿李고븷 닔 엳뿀떎. 蹂 뿰援ъ뿉 뵲씪, 닔닠 諛쏆 嫄댁쓽 諛섎履 嫄댁뿉꽌 愿李곕릺뒗 珥덉쓬뙆 씠긽 냼寃ъ 嫄댁쓽 怨쇱궗슜쑝濡 씤븳 諛쒖깮맂 냼寃ъ쑝濡 깮媛곷릺硫, 嫄 몢猿섏쓽 蹂솕媛 쓽誘 엳뒗 蹂솕 냼寃ъ쑝濡 궗猷뚮맂떎.

理쒓렐 뿰援ъ뿉 뵲瑜대㈃ 씠쟾뿉 븘궗젅뒪嫄 蹂묒쬆 吏꾨떒쓣 諛쏆 솚옄쓽 4.0%媛 븘궗젅뒪嫄 뙆뿴쓣 씪쑝耳곕떎怨 븯떎. 삉븳, 븘궗젅뒪嫄 蹂묒쬆씠 엳뒗 怨좊졊 솚옄媛 媛옣 痍⑥빟뻽怨, 씠윭븳 寃곌낵뒗 엫긽쓽媛 븘궗젅뒪嫄 蹂묒쬆 솚옄瑜 젏뜑 媛앷쟻쑝濡 愿李고븯뒗 뜲 룄씠 맆 닔 엳떎怨 蹂닿퀬븯떎21.

臾댁쬆긽 븘궗젅뒪嫄 蹂묒쬆뿉꽌 넻利 諛쒖깮뿉 븳 긽쟻 쐞뿕룄뒗 넂寃 蹂닿퀬릺뿀떎22. 蹂 뿰援ъ뿉꽌뒗 嫄 蹂묐씠 愿李곕맂 寃쎌슦굹 깉濡寃 넻利앹씠 諛쒖깮븯뿬룄 뙆뿴뿉 씠瑜대뒗 삁뒗 뾾뿀쑝硫, 넻利앹씠 吏냽릺뒗 寃쎌슦뿉뒗 嫄 蹂묐쓽 뿉肄붿꽦 냼寃ъ씠 愿李곕릺怨 珥덉쓬뙆 냼寃ъ 샇쟾뾾씠 吏냽릺뿀떎. 넻利앷낵 媛숈 엫긽쟻 利앹긽쓣 룞諛섑븳 寃쎌슦뿉뒗 珥덉쓬뙆瑜 씠슜븳 吏냽쟻씤 異붿떆 愿李곗씠 븘슂븯寃좊떎. 븯吏留 넻利앹씠 뾾뜑씪룄 嫄 蹂묒쬆쓽 냼寃ъ씠 愿李곕릺뿀떎硫 옣湲곗쟻씤 異붿떆 愿李곗쓣 넻빐 嫄 蹂묐쓽 蹂솕瑜 愿李고븯뒗 寃껋씠 嫄 뙆뿴쓣 삁痢≫븯湲 醫뗭쓣 寃껋쑝濡 깮媛곷맂떎.

蹂 뿰援ъ뿉뒗 紐 媛吏 젣븳젏씠 엳떎. 泥 踰덉㎏, 珥덉쓬뙆 寃궗媛 寃궗옄뿉 留ㅼ슦 쓽議댁쟻씠씪뒗 젏씠떎. 寃궗 寃곌낵뿉 寃궗옄 媛 삉뒗 寃궗옄 궡 媛꾩쓽 遺젙솗꽦씠 諛쒖깮븷 닔 엳떎뒗 젏쑝濡, 醫 뜑 媛앷쟻씠怨 蹂댄렪쟻씤 痢≪젙踰뺤씠 븘슂븷 寃껋씠떎. 몢 踰덉㎏, 嫄 蹂묐쓣 씪쑝궗 닔 엳뒗 궡쟻 슂씤 諛 쇅쟻 슂씤뿉 븳 遺꾩꽍씠 遺議깊뻽떎뒗 젏씠떎. 꽭 踰덉㎏뒗 12媛쒖썡쓽 吏㏃ 異붿떆 湲곌컙쑝濡, 嫄 蹂묐씠 吏꾪뻾븯뒗 뜲 뜑 留롮 떆媛꾩씠 냼슂맆 닔 엳뼱 옣湲곌컙쓽 異붿떆 愿李곗씠 뜑 븘슂븷 寃껋씠떎. 留덉留됱쑝濡, 떆媛꾩뿉 뵲瑜 嫄 蹂묐뿉 븳 삁愿 遺꾪룷 긽깭瑜 솗씤븯吏 紐삵뻽뜕 젏씠떎.

寃곕줎쑝濡, 湲됱꽦 븘궗젅뒪嫄 뙆뿴씠 엳뒗 솚옄뱾쓽 諛섎履 嫄댁 珥덉쓬뙆뿉꽌 뿉肄붿꽦 蹂묐 삉뒗 옒以꾩쁿議곗쭅 二쇰쓽 泥댁븸 瑜 쁽긽뱾쓣 珥덇린뿉 愿李고븷 닔 엳뼱 嫄 씠긽 냼寃ъ쓣 솗씤븷 닔 엳떎. 븯吏留, 씠윭븳 냼寃ъ씠 떆媛꾩씠 吏궓뿉 뵲씪 눜뻾꽦 蹂솕濡 吏꾪뻾븯吏뒗 븡븯쑝硫, 嫄댁쓽 몢猿 蹂솕留뚯씠 以묎컙 遺쐞뿉꽌 쓽誘 엳寃 愿李곕릺뿀떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization, Data curation, Investigation, Resources: JBK, BSP; Formal analysis, Methodology, Supervision: all authors; Project administration, Visualization: JBK; Validation: DGK, BSP; Writing–original draft: BSP. Writing–review & editing: DGK, JBK.

References
  1. Uquillas CA, Guss MS, Ryan DJ, Jazrawi LM, Strauss EJ. Everything Achilles: Knowledge Update and Current Concepts in Management: AAOS Exhibit Selection. J Bone Joint Surg Am 2015;97:1187-95.
    Pubmed CrossRef
  2. Sandelin J, Kiviluoto O, Santavirta S, Honkanen R. Outcome of sports injuries treated in a casualty department. Br J Sports Med 1985;19:103-6.
    Pubmed KoreaMed CrossRef
  3. Kannus P, J처zsa L. Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients. J Bone Joint Surg Am 1991;73:1507-25.
    Pubmed CrossRef
  4. Lantto I, Heikkinen J, Flinkkil채 T, Ohtonen P, Leppilahti J. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports 2015;25:e133-8.
    Pubmed CrossRef
  5. Leppilahti J, Orava S. Total Achilles tendon rupture. A review. Sports Med 1998;25:79-100.
    Pubmed CrossRef
  6. Ar첩en A, Helg첩 D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture. Scand J Med Sci Sports 2004;14:30-3.
    Pubmed CrossRef
  7. Pang BS, Ying M. Sonographic measurement of achilles tendons in asymptomatic subjects: variation with age, body height, and dominance of ankle. J Ultrasound Med 2006;25:1291-6.
    Pubmed CrossRef
  8. Archambault JM, Wiley JP, Bray RC, Verhoef M, Wiseman DA, Elliott PD. Can sonography predict the outcome in patients with achillodynia? J Clin Ultrasound 1998;26:335-9.
    CrossRef
  9. Jamadar DA, Jacobson JA, Theisen SE, et al. Sonography of the painful calf: differential considerations. AJR Am J Roentgenol 2002;179:709-16.
    Pubmed CrossRef
  10. Matthews W, Ellis R, Furness J, Hing W. Classification of tendon matrix change using ultrasound imaging: a systematic review and meta-analysis. Ultrasound Med Biol 2018;44:2059-80.
    Pubmed CrossRef
  11. Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med 2016;50:1187-91.
    Pubmed KoreaMed CrossRef
  12. Tan S, Kuda힊 S, 횜zcan AS, et al. Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiol 2012;41:1067-72.
    Pubmed CrossRef
  13. Li Q, Zhang Q, Cai Y, Hua Y. Patients with Achilles tendon rupture have a degenerated contralateral achilles tendon: an elastography study. Biomed Res Int 2018;2018:2367615.
    Pubmed KoreaMed CrossRef
  14. Holmes GB, Lin J. Etiologic factors associated with symptomatic achilles tendinopathy. Foot Ankle Int 2006;27:952-9.
    Pubmed CrossRef
  15. Drew BT, Smith TO, Littlewood C, Sturrock B. Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review. Br J Sports Med 2014;48:966-72.
    Pubmed CrossRef
  16. De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol 2009;193:W134-8.
    Pubmed CrossRef
  17. Doral MN, Alam M, Bozkurt M, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 2010;18:638-43.
    Pubmed CrossRef
  18. Mahieu NN, Witvrouw E, Stevens V, Van Tiggelen D, Roget P. Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective study. Am J Sports Med 2006;34:226-35.
    Pubmed CrossRef
  19. Waterston SW, Maffulli N, Ewen SW. Subcutaneous rupture of the Achilles tendon: basic science and some aspects of clinical practice. Br J Sports Med 1997;31:285-98.
    Pubmed KoreaMed CrossRef
  20. Weinfeld SB. Achilles tendon disorders. Med Clin North Am 2014;98:331-8.
    Pubmed CrossRef
  21. Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. Biomed Res Int 2017;2017:7021862.
    Pubmed KoreaMed CrossRef
  22. Matthews W, Ellis R, Furness JW, Rathbone E, Hing W. Staging Achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology. BMJ Open Sport Exerc Med 2020;6:e000699.
    Pubmed KoreaMed CrossRef