Novel Modalities and Normative Ultrasound Measures to Inform Clinical Care of Athletes With Posterior Lower Extremity Injuries- Big Sky Sports Medicine Conference

l. cin, s grogan, j persinger, j schroeder, n hager, r rossi, e metzger, c mincey, l wagner, b isaacson, p pasquina

Abstract accepted for poster presentation at the 2025 Big Sky Sports Medicine Conference

Lower extremity injuries are common sources of disability and time loss for  athletes and military servicemembers. Microvascular flow (MVF) and shear wave elastography  (SWE) may be non-invasive, efficient, and cost effective in early diagnosis and treatment of  musculoskeletal injuries (MSKIs). This study aimed to establish normative values for routine  tendon echo-characteristics, presence/absence of plantaris tendon, MVF vs Power Doppler (PD),  and SWE measurements in the posterior lower leg and Achilles tendon.

Ultrasound was performed on asymptomatic participants using a Samsung RS-85  Prestige. Orthogonal measurements were obtained along the Achilles at the calcaneal insertion  (CI), avascular zone (AVZ), gastro-soleus junction (GSJ), medial gastrocnemius, and soleus.  Outcomes included: thickness/width 2D imaging measurements, vessel quantification in PD &  MVF, SWE analysis, plantaris tendon visualization, Body Mass Index (BMI), ankle Range of  Motion (ROM), and self-reports (demographics & activity).

MVF detected flow in 9 limbs vs 1 by PD (n = 106). Increased BMI resulted in  increased tendon/gastroc measurements: (p < .01); SWE [r(63) = 0.41] & AVZ SWE [r(63) =  .33]. Long-Axis median: GSJ height = 0.2 cm, CI = 0.4 cm, & AVZ height = 0.5 cm. Short-Axis  mean AVZ width: males = 1.5 cm (SD: 0.2), females = 1.4 cm (SD: 0.2). Plantaris tendons  identified in > 50% of study population (59 out of 106 limbs).

Our findings will inform the normal, routine, and novel ultrasound values for the  Achilles tendon complex and its related structures. This may help improve the diagnosis and  treatment of MSKIs.