3D-ultrasound - A novel method for assessing the effect of LASER irradiation on repair of re-ruptured tendo-achilles

Abstract

3D-ultrasound - A novel method for assessing the effect of LASER irradiation on repair of re-ruptured tendo-achilles.

Liisa Laakso, Lee Barber; Griffith University, Gold Coast, Australia.

PURPOSE: This case study describes the treatment course of LASER used on a single subject with a history of re-rupture and surgical repair of the left tendo-achilles. We examine the utility of diagnostic ultrasound in normal axial B-mode versus a free-hand 3D ultrasound technique as a novel method for tracking the progress of healing using LASER photostimulation.

RELEVANCE: LASER is used widely in the clinical management of conditions in which the primary goal of treatment is tissue healing. For closed tissue injuries, it can be difficult to assess the effectiveness and progress of treatment particularly where a tendon has been repaired and remains immobilised. This presentation describes and compares two methods by which this may be possible.

METHODS: The subject was a professional stuntman (aged 29 years) seeking treatment for a torn tendo-achilles with a history of rupture, and re-rupture after 10 weeks, and intervening surgery for both episodes. Treatment consisted of 18 applications of LASER (830nm, continuous, 30mW, 0.5J/cm2 to each of 9 points, increasing to 1J/cm2 to each of a maximum 21 points) to the site of rupture and repair twice per week, over 7 weeks during tendon immobilisation in a removable splint. Normal axial B-mode ultrasound images were taken at commencement and completion of treatment, and at 4 months follow-up. 3D ultrasound imaging of tendon and gastrocnemius morphology was conducted at 4 and 5 months.

RESULTS: The clinical outcome using LASER was successful. Clinical assessment techniques demonstrated functional improvement but normal B-mode ultrasound images demonstrated the difficulties associated with assessment using conventional two dimensional imaging techniques. Conversely, free-hand 3-D ultrasound imaging demonstrated the potential utility of this method in providing additional morphological information and assisting visualisation chronologically and between affected and unaffected sides.

CONCLUSIONS: This presentation highlights the potential benefits of using free-hand 3D-ultrasound imaging in tracking the progress of tendon repair using LASER. As well as being a useful research tool, if the method can be simplified, it will be a useful clinical tool for the assessment of healing of closed tissue injuries.