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To evaluate the feasibility and reproducibility of quantitative ultrasonic measurement of normal Achilles tendon (AT) stiffness, using supersonic shear wave elastography (SWE) in correlation with its zonal anatomy. Materials and methods: Thirty tendons (8 women, 7 men) (mean age, 29,5 years; age range, 24-51 years) underwent morphologic and SWE measurements. The quantitative measurements of the tendon in four points (musculo-tendinous junction, tendinous body, pre-insertional area and enthesis) according to zonal anatomy were performed by two MSK radiologists and respectively expressed in terms of mm and Young’s modulus (kPa). Inter-observer reproducibility was also assessed. Results: The SWE measures show higher stiffness for the sagittal position of the US than in axial plane in all four AT levels (p<0.0382). Moreover, SWE measurements were significantly higher in dorsal flexion than in plantar flexion in all four AT levels (p<0.0317). Last, SWE visco-elasticity increases significantly from the musculotendinous junction to the pre-insertional and enthesis area (p<0.001) in plantar flexion. There was no significant interobsever difference for morphologic measurements and for stifness measurements in plantar and dorsal flexions (p>0.075). Conclusion: Quantitative measurement of normal AT using SWE is reproductible almost in plantar flexion, and increase from musculo-tendinous junction to enthesis and could now be integrated in our routine AT ultrasound exploration. Level of evidence: II.

Quantitative elastography of Achilles tendon using Shear Wave Elastography (SWE): correlation with zonal anatomy