Ultrasound Tissue Characterization (UTC) represents a groundbreaking advance that is transforming equine veterinary practice. Since its introduction in 1979, grayscale ultrasonography has been a pillar in the diagnosis of tendon injuries. This technology offered veterinarians a novel tool for visualizing tendon injuries at the time.
However, the limitations of grayscale ultrasonography have become apparent over the years. Traditional ultrasonography results in two-dimensional images of a three-dimensional structure that may miss or misrepresent the true extent of tendon damage. Leading to challenges in diagnosing the full scope of an injury and planning effective treatments. This limitation underscored the need for advancements like UTC imaging.
Unlike traditional ultrasonography, UTC offers a detailed, three-dimensional view of tendon and ligament injuries, providing a more comprehensive perspective on tendon health.
Tendinopathy, a collective term for tendon disorders, represents a clinical concept irrespective of pathogenesis. Tendon injuries might result from a single macro-trauma. However, there is increasing evidence suggesting that lesions in tendons are often preceded by a gradual disintegration that may have continued for months, or even longer, before injuries become clinically evident. Thus, clinical symptoms are frequently just the tip of the iceberg. This degradation results from aging and molecular inflammation after repetitive overuse. Early stages of disintegration might be manageable, but in the case of a tendon rupture, instances with underlying degeneration have significantly poorer prognoses.
Hence, timely detection is crucial and necessitates a pro-active rather than a re-active approach. Diagnosis isn’t simple—it isn’t a one-step process, and there is no panacea. Treatment and management must be individually tailored, based on the stage of the lesion and its loading capacity. Prior research indicates that tendon quality is determined at a young age and that, after maturation, the capacity to adapt diminishes. Excessive loads can therefore trigger a reactive phase in the tendon or lead to overstrain which may either restore or progress to disrepair and eventually to degeneration.
UTC answers the critical question of how to diagnose Tendinopathy at the earliest possible stage and how to monitor and adjust treatment accordingly.
UTC is a significant step forward in the diagnostics of tendon injuries, introducing an innovative approach to ultrasonographic imaging. The heart of this technology lies in an automated tracker that systematically moves the ultrasound transducer over the area of interest, capturing images at precise intervals. Every 0.2 mm the tendon is imaged in high resolution, creating a detailed ultrasound data block for 3D visualizations.
This technique visualizes and quantifies three-dimensional tendon integrity, and unlike conventional ultrasonography, UTC is highly reproducible due to standardized scanning and analysis.
The transducer is not operated manually but fixed in a transverse position in a tracking device, preventing transducer tilt. For good ultrasound contact the device is equipped with an acoustic coupling stand-off. The tracking system is battery-driven, allowing for the gradual movement of the transducer. As it sweeps along the tendon, transverse images are captured every 0.2 mm and stored in real-time in the system memory. The scan takes approximately 42 seconds.
On top of the unique 3D visualization, is the tissue characterization and the quantification of integrity. Based on the dynamics of echo patterns, UTC algorithms can distinguish four different echo-types, namely:
This UTC technology marks a significant advantage in the early detection of tendon and ligament injuries in horses. It allows veterinarians to assess tendon integrity at a microscopic level. This enables the detection of subtle changes indicative of emerging damage, such as slight collagen fiber disorganization or small areas of inflammation – aspects that traditional ultrasonography could not reveal.
Here is an example of a horse at the beginning of the season, showing no clinical symptoms. However, the UTC revealed a mild but significant presence of blue type 1 and red type 3 echoes. This tendon was in a reactive phase, typically reversible. Despite this, the rider decided to continue without treatment. After six weeks at a major event, the horse suffered a dramatic rupture, marking an abrupt end to the season.
This instance illustrates that UTC can discern the degenerative pathway that may lead to rupture well before clinical symptoms manifest. Early detection would have allowed for early intervention, improving the chances for recovery and reducing the rehabilitation period.
UTC technology changes how we view tendon injuries in horses, providing unprecedented accuracy in injury staging. By scanning every 0.2 mm of the tendon in detail and reconstructing a three-dimensional image, a veterinarian can closely examine the tendon’s structure, including the orientation and integrity of collagen fibers. This detailed information is essential for understanding the injury’s severity and developing a custom, targeted treatment for each horse’s unique needs. This represents a significant advancement in veterinary care, potentially reducing recovery time and significantly improving the chances of a complete recovery.
Utilizing UTC data to develop personalized rehabilitation programs offers a tailored approach to the recovery of horses with tendon injuries. The detailed insights provided by UTC into the structure and integrity of tendon tissue enable veterinarians and therapists to design highly specific rehabilitation plans. These plans are catered to the unique needs of each horse’s injury, considering its location, severity, and specific characteristics, facilitating a targeted path to recovery that increases the chance for complete healing and reduces the risk of recurrence.
This horse had no history of tendon pathology. After intense exercise, the superficial flexor tendon was, warm, and slightly swollen. Note the substantial increase in red type III echoes, indicative of fibrillar tissue because of disintegration (primary tendon failure), and a significant rise in black type IV echoes, indicative of free fluid, clearly visible in the 3-D coronal view.
Dr. Van Schie’s recommendation was to reduce exercise but definitively not to rest. Monitoring of the contralateral limb was also suggested to be conducted weekly. UTC parameters should normalize within 4 to 12 weeks. If not, the tendon has entered a tendinosis cycle, leading to persistent degeneration.
The deployment of UTC technology in equine veterinary practice signifies a pivotal moment in our approach to tendon injuries. With capacities to detect lesions early and stage them accurately, equine athletes can benefit from a more rapid and effective recovery. This ensures not only the maintenance of their value but also enables them to remain competitive in the sporting arena.
For owners, UTC offers an invaluable tool to extend the health and competitive lifespan of their horses by facilitating quicker recovery post-tendon injuries. For veterinarians, adopting UTC technology represents an investment that pays dividends through enhanced diagnostic and treatment capabilities. While mastering this technology requires training, comprehensive guidance is provided to support this learning curve, enabling professionals to efficiently incorporate UTC into their repertoire
With its ability to provide accurate diagnosis, aid in rehabilitation, and track progress objectively, UTC technology has become an essential tool for equine veterinarians and therapists.
Stay ahead in equine tendonitis management by embracing this innovative technology and incorporating it into your practice. Subcsribe to our newsletter and stay updated on the latest developments to harness the full potential of UTC in equine medicine. Join the UTC revolution today and ensure the well-being of your equine patients for years to come.