J Korean Foot Ankle Soc.  2022 Sep;26(3):123-129. 10.14193/jkfas.2022.26.3.123.

Correlation between the Fibrillar Pattern in Ultrasonography and Clinical Factors after Achilles Tendon Repair

  • 1Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
  • 2Yonsei Hangang Hospital, Seoul, Korea


To evaluate the correlation between the fibrillar pattern of the Achilles tendon on ultrasonography (US) and functional outcomes in patients who underwent open tendon repair after Achilles tendon rupture.
Materials and Methods
Data of 44 patients who had been subjected to US at least 6 months after repair, during the period between July 2012 and July 2019 were reviewed. Those with bilateral tendon rupture, re-rupture, open injury, and chronic or insertional rupture, were excluded from the review. We divided them into two groups, the homogenous group (HoP) and the heterogenous group (HeP) based on the fibrillar pattern on US. We also divided the HoP into linear and wavy subgroups, and the HeP into no hypoechoic lesion and hypoechoic lesion subgroups. The rupture type of the Achilles tendon, radiographic factors including US and magnetic resonance images, patient-related, surgical factors, and clinical results at the last visit after repair were assessed retrospectively.
The tendon thickness was 11.4±1.7 mm in the HoP, and 14.5±3.0 mm in the HeP (p<0.001). A shredded pattern was observed in 17 cases (65.4%) in the HoP, and in 17 cases (94.4%) in the HeP (p=0.031). The mean value of the number of sutures used was 8.9±3.05 in the HoP and 11.39±1.75 in the HeP (p=0.001). The mean value of the difference in calf circumference was 0.9±0.67 cm in the HoP and 1.36±0.71 cm in the HeP (p=0.037). There were no statistically significant differences in the fibrillar patterns and patient-related factors.
The fibrillar pattern observed after repair was correlated with the functional outcome and showed a significant relationship with the rupture pattern and the number of sutures used. Therefore, we suggest a careful individualized postoperative rehabilitation protocol to maximize functional outcomes by referring to the fibrillar pattern in US, especially in shredded ruptures.


Achilles tendon; Rupture; Repair; Ultrasonography; Fibrillar pattern


  • Figure 1 (A) Longitudinal scan of a homogenous fibrillary pattern showing parallel longitudinal architecture of the tendon. (B) Axial scan of a homogenous fibrillary pattern. (C) Longitudinal scan of a heterogenous fibrillary pattern showing not parallel longitudinal architecture of the tedndon. (D) Axial scan of a heterogenous fibrillary pattern showing multiple hypoechogenic area.

  • Figure 2 Flow charts of Achilles tendon rupture type and ultrasonographic findings.

  • Figure 3 Saggital magnetic resonance image of a Achilles tendon rupture. On T2-weighted image the Achilles tendon fiber is ruptured 5 cm above the calcaneal tubercle. Red arrow indicates the mixed high signal intensity of distal Achilles tendon stump meaning tendinopathy.

  • Figure 4 Intraoperative medical photo of Achilles tendon rupture fiber. (A) Simple rupture and (B) shredded rupture.

  • Figure 5 The mean value graph of tendon thickness of each group. The mean value showed an increase from homogenous group to heterogenous group. There is a significant difference between homogenous group and heterogenous group. There is no significant difference between linear pattern group and wavy pattern group, and no significant difference between no hypoechoic lesion group and hypoechoic lesion group.



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