The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study.
BACKGROUND
Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy.


OBJECTIVE
Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment.


METHODS
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.


CONCLUSIONS
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.
de Vos
Robert-Jan
RJ
The Hague Medical Centre Antoniushove, Sports Medicine Department, PO Box 411, Burgemeester Banninglaan 1, 2260 AK Leidschendam, The Netherlands.
Weir
Adam
A
Cobben
Lodewijk P J
LP
Tol
Johannes L
JL
D000125:Achilles Tendon / Q000098:blood supply / Q000000981:diagnostic imaging*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods*