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Eccentric training in patients with chronic Achilles tendinosis–normalized tendon structure and decreased thickness at follow-up
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
2004 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 1, 8-11 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2 6 cm level in the tendon.

Methods: The patients were examined with grey scale ultrasonography before and 3.8 years ( mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment.

Results: Twenty six tendons in twenty five patients ( 19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years ( range 1.6 - 7.75). All patients had a long duration of painful symptoms ( mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness ( at the widest part) had decreased significantly (p< 0.005) after treatment (7.6 (2.3) v 8.8 ( 3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading.

Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2004. Vol. 38, no 1, 8-11 p.
Keyword [en]
patellar tendinosis, magnetic resonance, surgical findings, ultrasonography, diagnosis, pathology, injuries
National Category
Sport and Fitness Sciences
Identifiers
URN: urn:nbn:se:umu:diva-2661DOI: 10.1136/bjsm.2001.000284ISI: 000188539400005OAI: oai:DiVA.org:umu-2661DiVA: diva2:140893
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2017-12-14Bibliographically approved
In thesis
1. The chronic painful Achilles tendon: sonographic findings and new methods for treatment
Open this publication in new window or tab >>The chronic painful Achilles tendon: sonographic findings and new methods for treatment
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the present thesis was to evaluate sonographic methods for investigation of the chronic painful Achilles tendon.

In a prospective study on patients with chronic painful mid-portion Achilles tendinosis, grey-scale ultrasound (US) showed a decreased tendon thickness and a “normalized” structure in the majority of patients successfully treated with eccentric calf-muscle training. By combining US with colour Doppler examination (CDV), a neovascularisation was shown in the region with structural tendon changes in all painful tendons, but not in any of the pain-free normal tendons. In a small pilot study, the sclerosing agent Polidocanol was injected towards the neovessels under US and CDV guidance. The majority of the patients became painfree and had no remaining neovessels, while the patients with remaining pain had remaining neovessels. The combined findings from US, immuno-histochemical analyses of biopsies, and diagnostic injections, showed that the patients were temporarily pain-free after US and CDV guided injections of local anaesthesia towards the region with neovessels, and biopsies from the region with tendon changes and neovascularisation showed nerve structures in close relation to blood vessels. The presence of neovessels was shown also in patients with chronic pain in the Achilles tendon insertion, and it was found that treatment with sclerosing injections cured the pain in the majority of patients. A good result of treatment was associated with no remaining neovessels.

In a prospective study on patients with chronic mid-portion Achilles tendinosis treated with eccentric training, CDV after treatment showed no remaining neovessels in the majority of the pain-free patients. In the patients with remaining tendon pain there were remaining neovessels. In conclusion, the findings in this thesis indicate that neovessels and accompanying nerves might be the source of chronic Achilles tendon pain. Sclerosing injections towards the neovessels, and eccentric training, seem to have a potential to cure the pain.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2003. 68 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 860
Keyword
Radiation sciences, Strålningsvetenskap
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-140 (URN)91-7305-536-0 (ISBN)
Public defence
2003-11-14, Umeå, 09:00 (English)
Opponent
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2012-04-03Bibliographically approved

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