BACKGROUND: Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. HYPOTHESIS: Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). RESULTS: Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r=.19, P=.131) and VISA-A score (r=-.23, P=.074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r=.43, P<.001) and VISA-A score (r=-.46, P<.001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. CONCLUSION: Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.
BACKGROUND: Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. HYPOTHESIS: Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). RESULTS: Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r=.19, P=.131) and VISA-A score (r=-.23, P=.074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r=.43, P<.001) and VISA-A score (r=-.46, P<.001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. CONCLUSION: Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.
Authors: Jeremy S Lewis; Syed A Raza; James Pilcher; Christine Heron; Jan D Poloniecki Journal: BMC Musculoskelet Disord Date: 2009-12-21 Impact factor: 2.362
Authors: Shannon E Munteanu; Karl B Landorf; Hylton B Menz; Jill L Cook; Tania Pizzari; Lisa A Scott Journal: J Foot Ankle Res Date: 2009-10-24 Impact factor: 2.303