title: Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US.
abstract: OBJECTIVE
  To evaluate the clinical relevance of neovascularization diagnosed with power Doppler ultrasonography (US) in Achilles tendons in patients with chronic achillodynia.
  
  
  METHODS
  Forty consecutive patients (mean age, 52 years; age range, 30-72 years) were examined. US was performed bilaterally and repeated after 3 months. Shape and echogenicity were assessed with gray-scale US and vascularization with power Doppler US. All patients were treated conservatively. Clinical assessment was performed after 0, 3, and 6 months by using visual analogue scale (VAS) scores (0, no pain; 100, unbearable pain). The VAS scores were compared with the initial US findings, and analysis of variance was used for repeated measurements.
  
  
  RESULTS
  Neovascularization was present in 30 of 55 painful tendons and in one of 25 asymptomatic tendons. The mean VAS scores at 0, 3, and 6 months, respectively, for tendons with neovascularization were 52, 26, and 20; those for tendons without neovascularization were 39, 19, and 18 (P =.15). Forty-eight painful and nine asymptomatic tendons were spindle shaped. The mean VAS scores at 0, 3, and 6 months, respectively, for the spindle-shaped tendons were 48, 25, and 20; those for normally shaped tendons were 33, 10, and 16 (P =.17). Thirty-five painful and four asymptomatic tendons were inhomogeneous. The mean VAS scores at 0, 3, and 6 months, respectively, for symptomatic inhomogeneous tendons were 54, 29, and 25; those for symptomatic homogeneous tendons were 32, 12, and 9 (P <.001).
  
  
  CONCLUSIONS
  Although neovascularization is a specific sign for pain, it does not indicate an unfavorable outcome. Conversely, tendon inhomogeneity seems to be associated with an unfavorable outcome.
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. marco.zanetti@balgrist.ch
authors.forename: Marco
authors.initials: M
authors.lastname: Zanetti
authors.forename: Alexander
authors.initials: A
authors.lastname: Metzdorf
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kundert
authors.forename: Hans
authors.initials: H
authors.lastname: Zollinger
authors.forename: Patrick
authors.initials: P
authors.lastname: Vienne
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
mesh_terms: D000125:Achilles Tendon / Q000098:blood supply* / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler