Degenerative Achilles tendon disease: assessment by magnetic resonance and ultrasonography

Neuhold, A; Stiskal, Michael; Kainberger, Franz; Schwaighofer, B.

doi:10.1016/0720-048x(92)90090-v

Cited by 77 publications

(39 citation statements)

References 12 publications

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“…Ultrasound and magnetic resonance imaging (MRI) are of assistance when clinical exam results are not sufficient to arrive at a diagnosis. 14,70,93 In a prospective head-to-head comparison between ultrasound and MRI that included blinding of examiners to the clinical assessment, which was used as the criterion, their performance in identifying Achilles tendinopathy was similar. 54 Imaging using ultrasound was reported to have a sensitivity of 80%, specificity of 49%, a positive predictive value (PPV) of 65%, and a negative predictive value (NPV) of 68%.…”

Section: Imaging Studiesmentioning

confidence: 99%

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Carcia

Martin²,

Houck³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

119

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The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

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Section: Imaging Studiesmentioning

confidence: 99%

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Carcia

Martin²,

Houck³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

119

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“…In clinical practice, US may be the first choice concerning chronic Achilles tendon disorders (Neuhold et al, 1992). However, MRI has a clear advantage over US, as the images more easily can be evaluated in a standardized manner in longitudinal studies (Movin, PhD thesis, 1998).…”

Section: Mrimentioning

confidence: 99%

Magnetic resonance imaging in chronic achilles tendinopathy

Shalabi

2004

Acta Radiol

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The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI-techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium enhanced T1-WI images (CME T1-WI) and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic painful Achilles tendinosis, before -and two years after -surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated to the histopathological findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 seconds) was seen in DEMRI in the symptomatic Achilles tendons with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed growing MRI-technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter-and intra-observer reliability. The technique was also used to prospectively follow up the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of one year we evaluated the biological effect of tendon repair following iatrogenic tendon injury by five transversal ultrasound-guided core-biopsies employing a needle technique in chronic Achilles tendinopathy. Alterations found during healing, such as tendon volume and intratendinous reactive changes could be monitored by MR imaging, and subsided as noted in the seven and twelve months follow-up. In study V, we evaluated the effect of treatment with three months daily-performed heavy loaded calf muscle strength training program in 25 patients who had been suffering from chronic painful Achilles tendinopathy. The tendon volume decreased with 14%, and the mean intratendinous signal with 23%. The clinical outcome was improved. In study VI, we revealed tendon adaptation immediately following calf muscle strength training. An MRI examination within 30 minutes of the performed exercises resulted in increased total tendon volume (12%) and mean intratendinous signal (31%).In conclusion, MRI-techniques can be used as an adjunct to clinical evaluation by monitoring morphological effects following different treatment interventions, thereby ...

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“…1 2 Gradual onset of pain in the Achilles tendon and structural changes on ultrasonography or magnetic resonance imaging is now called tendinosis. [3][4][5] The morphological characteristics of Achilles tendinosis are an area with a high concentration of glycosaminoglycans and irregular fibre structure and arrangement, but no inflammatory cell infiltrates. 6 The cause and pathogenesis are not known, and it is generally considered to be a difficult condition to treat.…”

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confidence: 99%

Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up

Öhberg

Lorentzon²,

Alfredson³

2004

Br J Sports Med

372

208

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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)v8.8 (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.

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Degenerative Achilles tendon disease: assessment by magnetic resonance and ultrasonography

Cited by 77 publications

References 12 publications

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Magnetic resonance imaging in chronic achilles tendinopathy

Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up

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