SLR - April 2012 - Timothy D. Howard
Reference: Hirschmuller A, Frey V, Konstantinidis L, Baur H, Dickhuth HH, Sudkamp NP, Helwig P. Medicine & Science in Sports & Exercise 44:2, 199-205, 2012.
Scientific Literature Review
Reviewed By: Timothy D. Howard, DPM
Residency Program: Grant Medical Center, Columbus, Ohio
Podiatric Relevance:
Achilles tendinopathy or tendinosis is a common condition frequently treated by the foot and ankle specialist. The condition in specifically in high level athletes can be associated with prolonged pain, restricted performance, or even premature end to their career. It can be a debilitating over-use injury. This study examined the use of doppler sonography as a tool for identifying important prognostic factors for Achilles tendinopathy.
Methods:
634 asymptomatic, adult runners were prospectively evaluated between March of 2007 to April 2008. Each patient to be included was a regular runner and had an absence of Achilles tendon complaints for at least one year with no history of previous rupture. All patients had power Doppler ultrasonography performed after a resting period of two hours with evaluation of thickness, vascularization, and structural abnormalities. Data was collected on age, sex, height, weight, training frequency, medical history, and intratendinous power Doppler flow. Questionnaires and follow up calls at 6 and 12 months were utilized for occurrence of new symptoms. All data was subjected to regression analysis to determine prognostic value of developing mid-portion Achilles tendinopathy.
Results:
Fourteen percent of subjects reported appearance of new symptoms in the Achilles region of interest. Prevalence of spindle-shaped thickening and hypoechoenicities was higher in subjects who subsequently developed mid-portion Achilles tendinopathy, but neovascularization on power Doppler ultrasonography proved to have the greatest positive predictive value for the development of mid-portion Achilles tendinopathy
Conclusions:
Regression analysis indicated intratendinous microvessels as a statistically significant factor in developing tendinopathy. The authors concluded that, although more expensive and time-consuming, the power Doppler ultrasonography is worthwhile for stratification of symptomatic Achilles tendinopathy and may be a tool to identify individuals in need of prophylactic care.