Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases

Åström, Maria; Gentz, C F; Nilsson, Patric; Rausing, Alf; Sjöberg, Staffan; Westlin, Nils E.

doi:10.1007/s002560050146

Cited by 271 publications

(96 citation statements)

References 21 publications

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“…Imaging is useful for documenting tendon changes, as well as ruling out other causes of patients' symptoms (Shalabi et al, 2001, Kader et al, 2002, Paavola et al, 2002a, Shalabi et al, 2004b, Shalabi et al, 2004c, Bleakney and White, 2005 US is a quick, safe and inexpensive method, but it is regarded as very user dependent and requires an experienced radiologist (Sandmeier and Renström, 1997). US is valuable for finding the occurrence and location of tendon lesions, but it is unable to differentiate between partial tendon ruptures and focal degenerative areas (Åström et al, 1996(Åström et al, , Paavola et al, 1998. Sometimes mild to moderate changes can be found in both symptomatic and asymptomatic tendons and the changes that are seen are not always related to patients' symptoms (Paavola et al, 1998, Fredberg and Bolvig, 2002, Peers et al, 2003b.…”

Section: Imaging Methodsmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Section: Imaging Methodsmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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“…Although both imaging techniques can locate lesions, they cannot differentiate between tendinosis and partial rupture. 5 Also, pathological findings correlate poorly with patient symptoms. 23 Khan et al 17 suggested that imaging may offer little additional information to experienced clinicians.…”

Section: Limitationsmentioning

confidence: 99%

Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial

Stevens

Tan²

2014

J Orthop Sports Phys Ther

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“…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). The literature suggests that MRI and US are superior to other imaging modalities in the detection and evaluation of intratendinous changes (Åström et al, 1996(Åström et al, , Movin et al, 1998. MR imaging can provide important information about the pathologic state of the Achilles tendon, and these imaging findings can provide information that is useful in patient treatment (Schweizer and Karasick, 2000).…”

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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Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases

Cited by 271 publications

References 21 publications

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial

Magnetic resonance imaging in chronic achilles tendinopathy

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