Shear waves elastography for assessment of human Achilles tendon's biomechanical properties: an experimental study

Introduction: Achilles tendon is the most frequently ruptured tendon, but its optimal treatment is increasingly controversial. The mechanical properties of the healing tendon should be studied further. Shear waves elastography (SWE) measures the shear modulus, which is proven to be correlated to elastic modulus in animal tendons. The aim of our study was to study whether the shear moduli of human cadaveric Achilles tendon, given by SWE, were correlated with the apparent elastic moduli of those tendons given by tensile tests. Materials and methods: Fourteen cadaveric lower-limbs were studied. An elastographic study of the Achilles tendon (AT) was first done in clinical-like conditions. SWE was performed at three successive levels (0, 3 and 6 cm from tendon insertion) with elastographic probe oriented parallel to tendon fibers, blindly, for three standardized ankle positions (25 plantar flexion, neutral position, and maximal dorsal flexion). The mean shear moduli were collected through blind offline data-analysis. Then, AT with triceps were harvested. They were subjected to tensile tests. A continuous SWE of the Achilles tendon was performed simultaneously. The apparent elastic modulus was obtained from the experimental stress-strain curve, and correlation with shear modulus (given by SWE) was studied. Results: Average shear moduli of harvested AT, given by SWE made an instant before the tensile tests, were significantly correlated with shear moduli of the same AT made at the same level, previously in clinical-like condition (p < 0.05), only in neutral position. There was a statistical correlation (p < 0.005) and a correlation coefficient R-2 equal to 0.95 +/- 0.05, between shear moduli (SWE) and apparent elastic moduli (tensile tests), for 11 tendons (3 tendons were inoperable due to technical error), before a constant disruption in the correlation curves. Discussion: We demonstrated a significant correlation between SWE of Achilles tendon performed in clinical like conditions (in neutral position) and SWE performed in harvested tendon. We also found a correlation between SWE performed on harvested tendon and apparent elastic moduli obtained with tensile tests (for 11 specimens). As a consequence, we can suppose that SWE of AT in clinical-like conditions is related to tensile tests. To our knowledge, the ability of SWE to reliably assess biomechanical properties of a tendon or muscle was, so far, only demonstrated in animal models. Conclusion: SWE can provide biomechanical information of the human AT non-invasively.