title: Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements.
abstract: Neovascularization is frequently observed in tendinopathy. Previous studies have focused on the role of neovascularization in Achilles tendinopathy, but have been conducted in small series. It is still unclear whether the degree of neovascularization is related to severity of symptoms. The purpose was to study the relationship between ultrasonographic neovascularization and clinical severity in patients with Achilles tendinopathy. In this prospective cohort study, data on 127 patients (141 tendons) were assembled from databases of three clinical trials. All patients followed an eccentric exercise program. The Öhberg neovascularization score (0-4+) and Victorian Institute of Sports Assessment-Achilles (VISA-A) score (split into domains: pain, function and activity) were collected during baseline and follow-up. The relationship between neovascularization and VISA-A score was calculated. At baseline, 107 tendons (76%) showed some degree of neovascularization. In 556 coupled measurements, neovascularization was weakly related to the VISA-A score [Exp (B) 1.017, 95% confidence interval (CI), 1.007-1.026]. No significant relationship was found between neovascularization and the pain domain (P = 0.277) and the activity domain (P = 0.283), but there was between neovascularization and the function domain of the VISA-A score [Exp (B) = 1.067, 95% CI 1.018-1.119]. In conclusion, neovascularization in Achilles tendinopathy is weakly related to clinical severity, mainly based on the function domain of the VISA-A score.
authors.affiliation: Sports Medicine Department, The Hague Medical Center, Leidschendam, The Netherlands; Department of Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: De Jonge
authors.forename: J L F
authors.initials: JL
authors.lastname: Warnaars
authors.forename: R J
authors.initials: RJ
authors.lastname: De Vos
authors.forename: A
authors.initials: A
authors.lastname: Weir
authors.forename: H T M
authors.initials: HT
authors.lastname: van Schie
authors.forename: S M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: J A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: J L
authors.initials: JL
authors.lastname: Tol
mesh_terms: D000125:Achilles Tendon / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000503:physiopathology; D018919:Neovascularization, Physiologic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D052256:Tendinopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015599:Trauma Severity Indices; D014463:Ultrasonography
keywords: Achilles tendinopathy; neovascularization; ultrasonography