Characteristics of Achilles Tendon Insertion on Posterior Aspect of the Calcaneus without Pathological Deformity in Adults: A Magnetic Resonance Imaging Study

Heuichul Gwak; Daewon Jung; Hyungtaek Park; Dongjun Ha; Jaeyong Kwak; Uicheol Kim

doi:10.14193/jkfas.2016.20.3.112

Journal List > J Korean Foot Ankle Soc > v.20(3) > 1043385

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Gwak, Jung, Park, Ha, Kwak, and Kim: Characteristics of Achilles Tendon Insertion on Posterior Aspect of the Calcaneus without Pathological Deformity in Adults: A Magnetic Resonance Imaging Study

Original Article

J Korean Ophthalmol Soc 2016;20(3):112-115.

Published online: 19 January 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.3.112

Characteristics of Achilles Tendon Insertion on Posterior Aspect of the Calcaneus without Pathological Deformity in Adults: A Magnetic Resonance Imaging Study

Heuichul Gwak^*, Daewon Jung, Hyungtaek Park^†, Dongjun Ha, Jaeyong Kwak, Uicheol Kim

Department of Orthopedic Surgery, Maryknoll Medical Center, Busan, Korea

^*Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

^†Department of Orthopedic Surgery, Mega Hospital, Gimhae, Korea

Corresponding Author: Daewon Jung Department of Orthopedic Surgery, Maryknoll Hospital, 121 Junggu-ro, Jung-gu, Busan 48972, Korea Tel: 82-51-461-2376, Fax: 82-51-463-1194, E-mail: daewon0809@naver.com

Received 16 April 20162 June 2016 Accepted 14 July 2016

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:

We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy.

Materials and Methods:

This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups.

Results:

The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0∼2.11 cm) and 2.36 cm (1.60∼2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group (1.47±0.25 cm) than in the middle insertion group (1.27±0.35 cm). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008).

Conclusion:

Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

Keywords: Achilles tendon, Calcaneus, Magnetic resonance imaging

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Figure 1.

Posterior aspect of calcaneus (γ), proximal insertion of Achilles tendon (α), distal insertion of Achilles tendon (β) were measured on a midsaggital slice of a T1-weighted ankle magnetic resonance imaging.

Figure 2.

This scatter plot and linear regression analysis reveals 0.38% proximal migration of distal insertion of Achilles tendon on calcaneus with a year (R²=0.04).

Table 1.

Measurement Results

	Proximal insertion group	Middle insertion group	Distal insertion group
Number of patients	0	75	20
Insertional length (cm)	-	1.27±0.35	1.47±0.25
Sex (male:female)	-	50:25	17:3
Age (yr)	-	43.4 (20∼69)	36.0 (20∼67)

Values are presented as number only, mean±standard deviation, or mean (range). Proximal insertion of Achilles tendon (α): 1.05 cm (0∼2.11 cm), distal insertion of Achilles tendon (β): 2.36 cm (1.60∼2.93 cm), posterior aspect of calcaneus (γ): 3.89 cm (3.19∼4.79 cm). Values are presented as mean length (range).

Table 2.

Intra Observer Reliability and Inter Observer Reliability

	Proximal insertion of Achilles tendon	Distal insertion of Achilles tendon	Posterior aspect of calcaneus
	ICC	ICC	ICC
Intra observer reliability
Observer 1	0.89	0.84	0.87
Observer 2	0.87	0.81	0.88
Observer 3	0.89	0.86	0.84
Inter observer reliability
Observer 1∼3	0.88	0.91	0.89

ICC: intra-class correlation coefficient.

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