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    ULTRASONOGRAPHIC FINDINGS OF THE ACHILLES TENDON IN ASYMPTOMATIC VOLUNTEERS AT THE KORLE BU TEACHING HOSPITAL, ACCRA.
    (Ghana College of Physicians and Surgeons, 2022-02-01) NIXON, HAROLD RICKETTS
    Introduction: The Achilles tendon (AT) is the thickest and strongest tendon in the human body. It is the conjoint tendon of the gastrocnemius and soleus muscles in the posterior compartment of the leg. It is one of the most commonly injured tendons and is frequently affected by a wide range of inflammatory and degenerative processes. However, AT pathology is often oligosymptomatic and under-evaluated; because symptoms and signs of tendon pathology are open to variable interpretation. Traditional methods of investigating the AT have been magnetic resonance imaging (MRI) and computed tomography (CT) and most of the existing data was obtained from non-African individuals. Noting that genetic differences between the races can result in phenotypic variability, it is likely that the existing data does not fully represent the asymptomatic African AT. Ultrasonography (USG) is a reliable, safe and inexpensive imaging modality for evaluating the AT. In our local setting; USG is the least expensive and most readily available of the available imaging modalities for evaluating the AT. However, there is no definitive work outlining the normal USG features of the AT in our region. This knowledge gap in the USG imaging findings of the AT causes delays in the diagnosis and cost-efficient management of AT pathology. This study sought to determine the USG characteristics of the AT in the asymptomatic population of an African country; thence defining the ‘normal’ USG characteristics of the AT.   Objective: To determine the ultrasonographic imaging findings of the Achilles tendon in asymptomatic volunteers at the Korle Bu Teaching Hospital, Accra. Materials and Methods: This was a hospital-based, cross-sectional study at the Radiology department of the Korle Bu Teaching Hospital. The participants (all asymptomatic volunteers above the age of 10 years) were selected with use of standardized questionnaires before inclusion into this study. USG examinations were carried out using a Toshiba Aplio 300 ultrasound machine (Toshiba medical systems corporation, Japan); equipped with a Linear Array 4.8-11 MHz transducer. In all patients, both ATs were scanned. Analysis: Captured data was analyzed in Statistical Package for Social Science (SPSS Inc., Chicago, IL, USA) version 25.0. The main outcome parameters being the echogenicity and thickness of the AT. Ankle dominance and other variables such as age, sex, height and BMI were expressed as percentages and/or graphs. Results: 342 subjects (including 162 males and 180 females) were recruited into the study and underwent bilateral ultrasound examination of their AT. 100% of the ATs reviewed were homogeneously hyperechoic - with mean thickness of 4.84 ± 0.92 mm. Males had thicker AT than females in all groups. 87.7% of dominant AT were thicker than non-dominant AT. Body height had a significant positive correlation with AT thickness. Conclusions: The asymptomatic AT is homogeneously hyperechoic and has mean thickness of 4.84 ± 0.92 mm on USG examination. Departures from these measurements should alert a radiologist to possible pathology when scanning a patient. The results of this study differ from other studies done on non-African populations; suggesting the need for further study on our indigenous population.