The Clinical Value of Real‐Time Shear Wave Elastography in Evaluating Closed Complete Achilles Tendon Ruptures

ABSTRACT Objective To evaluate the clinical value of real‐time shear wave elastography (RTSWE) in diagnosing complete closed Achilles tendon ruptures (ATRs), emphasizing preoperative assessment and postoperative healing monitoring. Methods A total of 72 consecutive patients with ultrasound‐confirmed complete closed ATRs (68 men, 4 women) participated. Morphometric parameters, including tendon gap length, rupture‐to‐insertion distance, and tendon thickness, were assessed by conventional ultrasound. Shear wave elastography (SWE) provided quantitative biomechanical data through shear wave velocity (SWV) measurements at the proximal and distal segments of ruptured and contralateral asymptomatic tendons, as well as adjacent soleus muscles. Results Patients' mean age was 37.14 ± 9.58 years, with a significant male predominance (94.4%). Ruptures occurred nearly equally in the left (52.8%) and right (47.2%) tendons. Morphological changes were significant, with increased thickness at proximal [6.81 (2.72) mm vs. 4.97 (0.92) mm; p < 0.001] and distal segments [8.22 (3.10) mm vs. 4.97 (0.92) mm; p < 0.001] compared to asymptomatic tendons. SWV analysis demonstrated significantly lower stiffness at the proximal segment of ruptured tendons compared with distal segments [3.55 (1.26) m/s vs. 4.87 (1.80) m/s; p < 0.001] and contralateral tendons [4.59 (1.64) m/s vs. 4.87 (1.80) m/s; p < 0.001]. Conclusion RTSWE provides valuable quantitative biomechanical information for preoperative planning and postoperative monitoring of complete closed ATRs. Elastographic changes remain confined to the free tendon segment without affecting the proximal musculotendinous junction of the soleus muscle, indicating compartment‐specific mechanical alterations following tendon rupture.