Ultrasound Imaging Evaluation of Textural Features in Athletes with Soleus Pathology—A Novel Case-Control Study

Abstract

Background: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls. Methods: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n=31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n=31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements. Results: Sociodemographic variables did not show statistically significant differences (p > .05). Ultrasound imaging measurements who reported statistically significant differences were EI (p = .001) and standard deviation (SD) (p = 0.001). MTh and EV variables did not show statistically significant differences (p = .381 and p = .364, respectively). Moreover, reliability values for the MTh (ICC = .911), EI (ICC = .982), SD (ICC = .955) and EV (ICC = .963). Based on these results the intra-rater reliability was considered excellent. Conclusion: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries.

Muscular Echovariation as a New Biomarker for the Classification of Soleus Muscle Pathology: A Cross-Sectional Study

“…To reduce probable mistakes, ROI size was the same in all participants and the location was the one that best identifies the muscle characteristics. Intra-rater reliability in the ROI selection has been reported in a previous study with the same dataset [7] In addition, inter-rater reliability, using the intraclass correlation coefficient, was established in a collection of 15 images as sufficient for clinical evaluation.…”

“…They were divided based on the muscle echogenicity in three groups: Injury Type 1 group, healthy group (Figure 1), Injury Type 1 and Injury Type 2 (Figure 2). As in previous studies [7,24], a central IMT tear in the soleus muscle was identified when patients reported having symptoms for at least six months, and they established a self-rated progressive stiffness value greater than or equal to 4 points during sports exercises or during the soleus stretching, measured using the numeric rating scale (NRS) [25]. The enrollment was carried out in a private clinic specialized in sports injuries.…”

“…The imaging study was performed offline with the ImageJ software (Bethesda, MD, USA) by a blinded tester. According to previous study [7], a range of interest (ROI) of 64 × 64 with an 8-bit gray scale using the ROI Manager tool was executed to extract the pixel distribution histogram. The ROI was considered as the muscle area without bone and fascia with the best reflection (Figure 1).…”

“…From a topographical point of view, five locations in the soleus muscle were recently identified like possible lesional sites [6]: two myofascial areas (posterior and anterior tears) and three musculotendinous junction points (proximal medial, proximal lateral and distal central tendon tears). Clinically, IMT injury is the most prevalent, being very common in sporting populations, such as dancers or soccer players [5,7]. This injury is characterized by several symptoms that the athlete describes as overload during sports activity, stiffness or lack of elasticity during stretching.…”

“…To our knowledge, EV has been used in patients with plantar fascia pathology [19], chronic lumbopelvic pain [20], dancers with asymptomatic Achilles tendon [21] and individuals with amyotrophic lateral sclerosis [22]. Regarding muscle injuries in sports people, De-la-Cruz-Torres et al [7] found that central IMT injury of soleus muscle is characterized by a minor EI. However, they found no differences in EV between healthy subjects and patients with soleus pathology.…”