Dynamic Ultrasound Imaging for Insertional Achilles Tendinopathy: A Cross‐Sectional Study

OBJECTIVES: Recently, a novel dynamic maneuver in which the retrocalcaneal soft tissues are squeezed (CoRi sign) has been described for the diagnosis of partial tears involving the deep fibers of the Achilles tendon. This cross-sectional study aims to assess the prevalence of the CoRi sign in a cohort of patients with a clinical diagnosis of IAT. METHODS: A consecutive cohort of 58 patients (32 males, 26 females) seen at our institution with a clinical diagnosis of IAT comprised the study group for a cross-sectional study to assess the prevalence of the CoRi sign in the study population and to correlate the findings on static B-mode and color/power Doppler sonography with the CoRi dynamic maneuver. RESULTS: The prevalence of CoRi sign was 15.5% in the study cohort (9/58) and 26.4% (9/34) in the subgroup of IAT patients with bursal effusion in B-mode coupled with synovial hyperemia in color/power Doppler. Of the nine patients with a positive dynamic maneuver, eight of them presented insertional tendinosis with intratendinous hyperemia at color/power Doppler; in addition, none showed Achilles bone spurs of the calcaneal tuberosity. Lastly, four of the nine patients with a positive CoRi sign showed tendon-bone junction hyperemia in the absence of a bone spur. CONCLUSIONS: Tendon undersurface disruption in IAT patients is not uncommon, and dynamic ultrasound imaging is valuable for diagnosis. Hyperemic retrocalcaneal bursitis, insertional tendinosis with intratendinous hyperemia, and tendon-bone junction hyperemia are the most common static sonographic findings, respectively, in CoRi-positive patients. LEVEL OF EVIDENCE: Level IV-cross-sectional study.