Ultrasound-guided injection of the achilles paratenon: A cadaveric investigation

This study shows that ultrasound can be used to selectively inject the Achilles paratenon in a precise and controlled way. Using an in-plane medial-to-lateral approach, the operator could place the needle into the paratenon lumen while avoiding the Achilles tendon itself, the Kager’s fat pad, and the overlying fascial compartment. This is clinically relevant because the paratenon is considered an important pain source in midportion Achilles tendinopathy, so accurate targeting may improve future treatment strategies.

Interesting highlights:

• The study confirmed correct dye placement in the paratenon lumen in 80% of injected tendons.

• The technique was designed to improve full needle visibility in real time, which is a practical advantage during intervention.

• No dye spread was seen into the Kager’s fat pad or inside the fascial compartment in the successful injections.

• The paper also describes a potential pitfall: “double puncturing”, which can cause unintended superficial spread of injectate.

Who is this article most useful for?
MSK ultrasound clinicians, sports medicine physicians, PM&R specialists, foot and ankle specialists, and interventional sonographers managing Achilles region pain.