• Olivier C Dams, ReiningaInge H FIHFUniversity of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands., Jan L Gielen, Inge van den Akker-Scheek, and Johannes Zwerver.
• University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: O.C.Dams@umcg.nl.
• Injury. 2017 Nov 1; 48 (11): 2383-2399.

ObjectiveTo determine the role of imaging in the diagnosis and monitoring of the Achilles tendon rupture (ATR).Study DesignSystematic review.Data SourcesPubMed and EMBASE in November 2016.Eligibility CriteriaClinical studies providing information on the methods and role of imaging in the diagnosis and monitoring of the ATR were included.ResultsFifty-six studies were included, most concerning the use of ultrasound (n=37) or MRI (n=18). Seven studies provided data on the diagnostic accuracy of imaging. Most ultrasound studies used a 7.5MHz probe (19/32 studies) and scanned the patient bilaterally in prone position, with recent studies tending to use higher frequency probes (r=0.42). Sensitivity [for detecting a rupture] ranged from 79.6 to 100%; the spread in specificity was large but two studies showed perfect (100%) data. Negative and positive likelihood ratios ranged from 0 to 0.23 and 1.0 to 10 respectively. MRI examination was generally performed with 1.5Tesla (T) MRI (6/12 studies) with a strong trend for higher T strength in more recent studies (r=0.71). One study reported a sensitivity of 90.9% and one a specificity of 100%. Although imaging can visualize structure and healing, these results were generally not related to the clinical picture. Overall, ultrasound was recommended over MRI for diagnosis and monitoring. Results of other imaging modalities remain inconclusive.ConclusionThe adjunct role of imaging, especially of ultrasound and MRI, in the diagnosis and monitoring of ATRs was established. It is therefore recommended to rely primarily on the clinical examination and evaluation and to use imaging for ruling out other injuries and providing additional clinical information. More high-quality research is warranted into the diagnostic accuracy of imaging as well as less conventional imaging modalities' diagnostic and monitoring capabilities.Copyright © 2017 Elsevier Ltd. All rights reserved.

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