Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis

Gibbon, Wayne; Cooper, Jeff; Radcliffe, Graham

doi:10.1002/(sici)1097-0096(200002)28:2<61::aid-jcu1>3.0.co;2-r

Cited by 94 publications

(50 citation statements)

References 33 publications

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“…Vascular ingrowth, as already said, has the aim to repair tendon's defects, but it has been found to correlate with the location of pain in patients with symptomatic tendinopathy [127] . Neovascularization with thick walls, a tortuous appearance and small lumen ventral from the Achilles tendon and in the paratenon is found in 50-88% of symptomatic tendons but not in pain-free tendons [128,129] ; these blood vessels are accompanied by sensory neonerves [130,131] causing an increase in pain signaling by producing nociceptive substances such as glutamate, substance P, calcitonin gene-related peptide (CGRP) past the critical threshold [132,133] . Myofibroblasts proliferate and are transported by the new blood vessels into the peritendineum and the tendon proper [16,30] .…”

Section: Discussionmentioning

confidence: 99%

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The Achilles Tendinopathy: Pathogenesis Review

Bondi¹,

Rossi²,

Magnan³

et al. 2015

International Journal of Orthopaedics

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Achilles tendinopathy is a degenerative disease with high prevalence in runners. For the comprehension of achilles tendinopathy we have to consider intrinsic conditions such as age, sex, BMI, tendon temperature, systemic diseases, flexibility, previous injuries and anatomical variations, genetic predisposition and blood supply and extrinsic factors such as drugs and overuse. Both categories can be responsible for development of achilles' degenerative tendinopathy. Different hypothesis were studied, those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis.

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Section: Discussionmentioning

confidence: 99%

“…This is supported by the finding that most ultrasonographic mid-portion disorders (91%) are found in the posteromedial segment of the tendon [131,135] . The Plantaris Longus…”

Section: The Plantaris Longus Tendon and Its Relationship With The Acmentioning

confidence: 99%

The Achilles Tendinopathy: Pathogenesis Review

Bondi¹,

Rossi²,

Magnan³

et al. 2015

International Journal of Orthopaedics

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“…9,10,26 In current practice, there are several sonographic findings that may suggest a diagnosis of tendinopathy, including increase in tendon caliber, altered fibrillar echotexture, and increased tendon vascularity. 8,9 In our study, tendinopathic tendons were significantly larger than normal controls at the midportion of the tendon and at the calcaneal insertion. The distal predominance for tendon swelling is different from that reported by Gibbon et al 8 in a cohort of similar age in which tendon swelling was primarily confined to the proximal two thirds of the Achilles tendon, though these differences may be explained by the semiquantitative measure used by the invesigators.…”

Section: Discussionmentioning

confidence: 99%

“…2 Sonography is commonly used to evaluate the Achilles tendon and paratendinous structures (subcutaneous tissues, Kager's fat pad [or preAchilles fat pad], bursae, calcaneal insertion, and plantar fascia). Although some features relating to chronic Achilles tendinopathy have been described previously, [7][8][9][10][11][12][13] there are no established sonographic diagnostic criteria for this entity. The purpose of our study was to analyze the sonographic appearances of Achilles tendon in normal subjects and in patients with chronic Achilles tendinopathy with the aim of establishing diagnostic sonographic criteria for chronic Achilles tendinopathy.…”

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confidence: 82%

Sonography of chronic Achilles tendinopathy: A case–control study

Leung

Griffith

2007

J of Clinical Ultrasound

107

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Purpose. To describe the sonographic appearance of Achilles tendon in normal subjects and patients with chronic Achilles tendinopathy with the aim of establishing diagnostic sonographic criteria for Achilles tendinopathy.Methods. A prospective, cross-sectional, case-control sonographic study of the Achilles tendon was undertaken. Thirty tendons in 21 patients and 100 tendons in 50 control subjects were selected. Sonographic assessment included tendon thickness, echogenicity, fibrillar pattern, and presence of calcifications. Power Doppler imaging was used to assess tendon vascularity. Paratendinous structures and plantar fascia were also examined.Results. Tendinopathic tendons were larger than normal tendons in both cross-sectional area and anteroposterior diameter. Hypoechoic areas within the tendon were more commonly seen in patients. Disruption of fibrillar pattern, increase in tendon vascularity, increased Kager's fat pad echogenicity, and paratenon thickening were solely seen in patients. Fluid in the retrocalcaneal bursa and calcaneal bony abnormalities were seen in both groups without a significant difference.Conclusion. Achilles tendinopathy results in enlargement, particularly of the mid-and distal portions of the tendon, disruption of fibrillar pattern, and increase in tendon vascularity. Additional signs are increased Kager's fat pad echogenicity and paratenon thickening. Tendon calcification, changes in retrocalcaneal bursae, and calcaneal contour are not specific for Achilles tendinopathy.

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“…The lateral radiograph may show a prominent superior tuberosity of the os calcis. Ultrasounds of athletes with chronic Achilles tendinosis have found that this modality accurately demonstrates both tendonitis and tendinosis of the tendon [19,20].…”

Section: Diagnosismentioning

confidence: 99%

Shock wave therapy for Achilles tendinopathy

Wilson

Stacy

2010

Curr Rev Musculoskelet Med

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Achilles tendinopathy has been reported as the most common overuse injury in sports medicine clinics (Clement et al. Am J Sports Med 12: 179-184, 1984). Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of patients. When conservative therapy fails, other noninvasive treatment measures may be considered. Extracorporeal shock wave therapy (ESWT) has been used in soft-tissue disorders including lateral epicondylitis, plantar fasciitis, and calcific tendonitis of the shoulder. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is lacking. This article explores the role of shock wave therapy in the management of recalcitrant Achilles tendinopathy in patients attempting to avoid an invasive intervention.

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Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis

Cited by 94 publications

References 33 publications

The Achilles Tendinopathy: Pathogenesis Review

The Achilles Tendinopathy: Pathogenesis Review

Sonography of chronic Achilles tendinopathy: A case–control study

Shock wave therapy for Achilles tendinopathy

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