Gastrocnemius Tendinosis

NewsBot · Sep 30, 2015

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Gastrocnemius Tendinosis- A Frequent Finding on MRI knee Examination
Anugayathri Jawahar, , Yanan Lu, Gokcan Okur, Stephanie Kliethermes, Laurie Lomasney
European Journal of Radiology; 25 September 2015

Highlights
?Gastrocnemius tendinosis was identified in 50% of the MRI examinations completed in patients evaluated for both posterior and non-posterior knee pain.
?There was predominant involvement of the medial head of gastrocnemius tendon and was of mild grade.
?Presentation for posterior knee pain as well as limited joint motion did have an association with GT. Multivariate analysis yielded a relationship between the combined clinical features of clinical joint effusion and posterior knee pain with GT.
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Objective
Gastrocnemius tendinosis (GT) is one potential cause for posterior knee pain, commonly overlooked on clinical examinations and imaging. This study assesses the frequency of GT on MR imaging in a convenience sample based on a database search and associations with other articular pathologies and clinical findings.

Subjects and Methods
With IRB approval, retrospective review was completed on 300 randomly selected MR knee exams performed from February 2009 to June 2010. Following de-identification, axial T2 and sagittal PD images, with or without fat suppression, were reviewed by 2 radiologists. The gastrocnemius tendon femoral attachments were graded as normal, mild (few cysts, thickening, intermediate signal) or severe GT (multiple cysts, marrow edema, tear). Select associated MR findings of internal derangement were documented. Clinical charts were reviewed for clinical presentation, physical exam findings, and select demographics.

Results
The inter-observer reliability for presence/grading of GT was very high (kappa statistic=0.97). Frequency of GT was 50.33%, most frequently involving medial head of gastrocnemius (63.6%). Grades of GT were 41.7% and 17.2% for mild and severe respectively. Univariate analysis showed statistically significant relationship between grade of GT with arthrosis (p=0.05) and clinical joint effusion (p=0.02). Multivariate analysis showed higher odds of severe GT for individuals with medial plus lateral GT. Statistical significance was noted for presence of both GT and ACL tear (13.9%; p=0.02).

Conclusion
Significant findings of our analysis included GT presented with predominant involvement of medial head of gastrocnemius tendon, mild in severity, strong association with ACL tear, presented frequently as posterior knee pain, limited joint motion and clinical joint effusion. However, there was no statistically significant association between demographic features and medical comorbidities in the patients. Increased understanding of frequency of GT allows more accurate reporting of MR knee exam and systematic search for associated abnormalities.
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