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Purpose: Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique., Methods: 37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated., Results: The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660-0.880, p < 0.001) when positioned at 2 cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1 cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032-0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise., Conclusion: Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice., Competing Interests: Fernando Alfageme Speaker honoraria: GE, Mindray; Equipment support: EsaoteDavid Bong No Conflicts of interestAngel Bueno No Conflicts of interestVito Cantisani Speaker honoraria: Bracco, Samsung, CanonPaz Collado No Conflicts of interestMaria Antonietta D'Agostino No Conflicts of interestDaniela Fodor No Conflicts of interestJavier de la Fuente No Conflicts of interestWolfgang Hartung Speaker honoraria: Abbvie, GE Healthcare, Alpinion Medical; Ultrasound equipment support; Alpinion Medical Germany, Canon Medical GermanyHilde Hammer Speake honoraria and/or consultancy; AbbVie, Lilly, Roche, NovartisAndrea Klauser No Conflicts of interestJens Kessler No Conflicts of interestManuela Lenghel No Conflicts of interestCarlo Martinoli Speaker honoraria and equipment support: Philips, CanonDolores Mendoza-Cembranos No Conflicts of interestMihaela Micu No Conflicts of interestIngrid Möller No Conflicts of interestAurelie Najm No Conflicts of interestGabriella Iohom No Conflicts of interestClara Malattia No Conflicts of interestPeter Mandl No Conflicts of interestEsperanza Naredo No Conflicts of interestLevent Ozcakar No Conflicts of interestRiccardo Picasso No Conflicts of interestAthena Plagou Speaker honoraria: GESebastian C Rodriguez-Garcia No Conflicts of interestXavier Sala-Blanch No Conflicts of interestLuca Scofienza Non-financial support: Samsung Imaging, Abiogen, Bracco Imaging Italia; Speaker honoraria: Esaote SPA, Abiogen, Biolive, Fidia Pharma Group, Novartis, PfizerOana Serban No Conflicts of interestPaolo Simoni No Conflicts of interestIwona Sudoł-Szopińska No Conflicts of interestLene Terslev Speaker honoraria: GEChristian Tesch No Conflicts of interestPlamen Todorov No Conflicts of interestJacqueline Uson No Conflicts of interestVioleta Vlad No Conflicts of interestFederico Zaottini No Conflicts of interestMichael Pelea, Diana Bilous, Anamaria Marian, Roxana Gutiu No conflict of interest., (Thieme. All rights reserved.)

The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice., Competing Interests: Fernando Alfageme: Speaker honoraria: GE, Mindray; Equipment support: EsaoteDavid Bong: No Conflicts of interestAngel Bueno: No Conflicts of interestVito Cantisani: Speaker honoraria: Bracco, Samsung, CanonPaz Collado: No Conflicts of interestMaria Antonietta D’Agostino: No Conflicts of interestDaniela Fodor: No Conflicts of interestJavier de la Fuente: No Conflicts of interestWolfgang Hartung: Speaker honoraria: Abbvie, GE Healthcare, Alpinion Medical; Ultrasound equipment support; Alpinion Medical Germany, Canon Medical GermanyHilde Hammer: Speake honoraria and/or consultancy; AbbVie, Lilly, Roche, NovartisAndrea Klauser: No Conflicts of interestJens Kessler: No Conflicts of interestManuela Lenghel: No Conflicts of interestCarlo Martinoli: Speaker honoraria and equipment support: Philips, CanonDolores Mendoza-Cembranos: No Conflicts of interestMihaela Micu: No Conflicts of interestIngrid Möller: No Conflicts of interestAurelie Najm: No Conflicts of interestGabriella Iohom: No Conflicts of interestClara Malattia: No Conflicts of interestPeter Mandl: No Conflicts of interestEsperanza Naredo: No Conflicts of interestLevent Ozcakar: No Conflicts of interestRiccardo Picasso: No Conflicts of interestAthena Plagou: Speaker honoraria: GESebastian C Rodriguez-Garcia: No Conflicts of interestXavier Sala-Blanch: No Conflicts of interestLuca Scofienza: Non-financial support: Samsung Imaging, Abiogen, Bracco Imaging Italia; Speaker honoraria: Esaote SPA, Abiogen, Biolive, Fidia Pharma Group, Novartis, PfizerOana Serban: No Conflicts of interestPaolo Simoni: No Conflicts of interestIwona Sudoł-Szopińska: No Conflicts of interestLene Terslev: Speaker honoraria: GEChristian Tesch: No Conflicts of interestPlamen Todorov: No Conflicts of interestJacqueline Uson: No Conflicts of interestVioleta Vlad: No Conflicts of interestFederico Zaottini: No Conflicts of interestMichael Pelea, Diana Bilous, Anamaria Marian, Roxana Gutiu: No conflict of interest, (Thieme. All rights reserved.)