Monitoring of Muscle, Tendon and Ligament Repair

29.7 Conclusion

Appearances of acute muscle, tendon and ligament injury are well documented but thus far imaging has had a limited role in assessment of such injuries during healing. In this context ultrasound and MRI have been largely used to detect complications when clinical progress is unsatisfactory. Normal healing appearances have been documented at sites such as the Achilles tendon, hamstring musculature and cruciate ligaments and in many cases abnormalities persist for some time. Given that abnormality is present for weeks following muscle injury and months following tendon and ligament injury, follow-up imaging shortly after injury may be difficult to interpret and as yet, a clear relationship between imaging findings and clinical outcome has not been shown. At present, there are few specific criteria that may be used to distinguish normal from inadequate healing but persisting separation of muscle, tendon or ligament components is a reliable indicator of inadequate healing. Absence of regression of fluid at the site of injury or an increase in the extent of abnormality at follow-up may also be used to indicate an inadequate healing response. Algorithms integrating imaging findings into clinical management are not yet available and the ultimate role of follow-up imaging will depend upon its capacity to alter management and predict adverse outcomes.