title: Preliminary Treatment of Achilles Tendinopathy Using Low-Intensity Pulsed Ultrasound.
abstract: BACKGROUND
  Achilles tendinopathy is a degenerative process of the tendon associated with diminished vascularity, microtrauma, and aging. Nonoperative treatments such as activity modification, immobilization, night splints, and physical therapy have good outcomes for the majority of patients. However, there are cohorts of patients that remain symptomatic despite use of all nonoperative measures that eventually require surgical intervention. The present study reports the preliminary short-term clinical outcomes of low-intensity pulsed ultrasound (LIPUS) for treatment for Achilles tendinopathy.
  
  
  METHODS
  Fourteen patients with clinically diagnosed Achilles tendinopathy who failed previous nonoperative treatments underwent LIPUS stimulation directly over the area of maximum tendon tenderness for 20 min/d for 8 weeks total. No other treatment modalities were used during the period of LIPUS stimulation. All patients had serial clinical exams and evaluations with an average follow-up of 12 months (range, 6-50 months).
  
  
  RESULTS
  Excellent clinical outcomes with complete resolution of pain and other symptoms were obtained in 7 patients (50%). Two patients (14%) had good outcomes with mild tendon irritation and stiffness not requiring further intervention. Five patients (36%) had minimal benefit with continued pain, swelling, and tenderness over the Achilles and functional deficits. No patients had worsening pain or progression of disability requiring surgery.
  
  
  CONCLUSIONS
  LIPUS is an additional noninvasive treatment modality for chronic Achilles tendinopathy that may potentially help improve clinical symptoms and delay and/or prevent the need for surgical intervention. While LIPUS is easy to use, well-tolerated, and has promising early clinical results, further research is needed to determine the long-term benefits, disadvantages, and cost-effectiveness of this alternative treatment for tendinopathy.
  
  
  METHODS
  Therapeutic, Level IV: Case series.
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina (ARH)Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (GBH) andyhsu1@gmail.com.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina (ARH)Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (GBH).
authors.forename: George B
authors.initials: GB
authors.lastname: Holmes
mesh_terms: D000125:Achilles Tendon; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012648:Self Care; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
keywords: Achilles tendon; Exogen; LIPUS; bone stimulator; low-intensity pulsed ultrasound; tendinopathy; ultrasound