Neovascularization and Pain in Abnormal Patellar Tendons of Active Jumping Athletes

Cook, Jill; Malliaras, Peter; Luca, J. De; Ptasznik, Ronnie; Morris, Meg E.; Goldie, Patricia A.

doi:10.1097/00042752-200409000-00008

Cited by 88 publications

(97 citation statements)

References 9 publications

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“…7,31 This increase is typical in those who have had plantar fasciitis for less than 12 months, and has been associated with greater intensity of pain. 31 Similar vascularization has been observed in patients with Achilles, 23,36 patellar, 9 and rotator cuff tendinopathy. 18 The intensity of pain with chronic tendinopathy has also been found to be greater in patients with tendon vascularization compared to those without.…”

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confidence: 56%

“…18 The intensity of pain with chronic tendinopathy has also been found to be greater in patients with tendon vascularization compared to those without. 9,10,38 Alfredson 2 proposed that vascularization in diseased tendons is one of the potential mediators of pain in tendinopathy, nerve ingrowth associated with new vessels being the cause of pain reported by patients.…”

mentioning

confidence: 99%

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Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis

Chen¹,

Ho²,

Ying³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Plantar fasciitis is one of the most common painful foot con ditions. It affects both active and sedentary adults, with a peak incidence in those between 40 and 60 years of age. 8,20 Impaired vascularity with subsequent metabolic disturbance has been proposed as one of its causes.11,31 A moderate to marked increase in vascularity in the proximal plantar fascia has been observed in patients with plantar fasciitis. 7,31 This increase is typical in those who have had plantar fasciitis for less than 12 months, and has been associated with greater intensity of pain.31 Similar vascularization has been observed in patients with Achilles, 23,36 patellar, 9 and rotator cuff tendinopathy. 18 The intensity of pain with chronic tendinopathy has also been found to be greater in patients with tendon vascularization compared to those without. 9,10,38 Alfredson 2 proposed that vascularization in diseased tendons is one of the potential mediators of pain in tendinopathy, nerve ingrowth associated with new vessels being the cause of pain reported by patients.Higher tendon vascularity has also been reported to be associated with greater dysfunction in patients with patellar 9 and Achilles tendinopathy. T T METHODS:Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. T T RESULTS:There were significantly higher VI (mean  SD, 2.4%  1.4%) and fascia thickness (5.0  1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4%  0.5%; fascia thickness, 3.3  0.7 mm) and with the dominant side of the controls (VI, 1.6%  0.4%; fascia thickness, 2.9  0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. T T CONCLUSION: Individuals with unilateralchronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia vascularity and thickness were associated with foot dysfunction in patients with chronic plantar fasciitis. Public trials registry: Current Controlled Trials, ISRCTN49594569. J...

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confidence: 56%

mentioning

confidence: 99%

Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis

Chen¹,

Ho²,

Ying³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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“…This finding suggests that angiogenesis plays an important role in pain-experienced in tendinopathy condition [6,7]. These data are in accordance with clinical studies showing that strategies to destroy neovessels (i.e local injection of a sclerosing agent, polidocanol) lead to pain improvement [7]. Etamsylate, an inhibitor of fibroblast growth factor (FGF), when locally applied, supresses FGF-driven angiogenesis [8,9].…”

Section: Discussionsupporting

confidence: 66%

“…It has been reported that nerves appear to travel in close association to tendon neovessels [5]. This finding suggests that angiogenesis plays an important role in pain-experienced in tendinopathy condition [6,7]. These data are in accordance with clinical studies showing that strategies to destroy neovessels (i.e local injection of a sclerosing agent, polidocanol) lead to pain improvement [7].…”

Section: Discussionsupporting

confidence: 62%

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“…Neovascularization has gained increasing attention in rheumatology and in human tendon studies (50)(51)(52)(53). Color and power Doppler analyses can demonstrate hyperemia in painful tendons (54), and therapy with sclerosing agents shows promise (55).…”

Section: Discussionmentioning

confidence: 99%

Tenocyte responses to mechanical loading in vivo: A role for local insulin‐like growth factor 1 signaling in early tendinosis in rats

Scott

Cook

Hart

et al. 2007

Arthritis & Rheumatism

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138

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Objective. To investigate tenocyte regulatory events during the development of overuse supraspinatus tendinosis in rats.Methods. Supraspinatus tendinosis was induced by running rats downhill at 1 km/hour for 1 hour a day. Tendons were harvested at 4, 8, 12, and 16 weeks and processed for brightfield, polarized light, or transmission electron microscopy. The development of tendinosis was assessed semiquantitatively using a modified Bonar histopathologic scale. Apoptosis and proliferation were examined using antibodies against fragmented DNA or proliferating cell nuclear antigen, respectively. Insulin-like growth factor 1 (IGF-1) expression was determined by computer-assisted quantification of immunohistochemical reaction. Local IGF-1 signaling was probed using antibodies to phosphorylated insulin receptor substrate 1 (IRS-1) and ERK-1/2.Results. Tendinosis was present after 12 weeks of downhill running and was characterized by tenocyte rounding and proliferation as well as by glycosaminoglycan accumulation and collagen fragmentation. The proliferation index was elevated in CD90؉ tenocytes in association with tendinosis and correlated with increased local IGF-1 expression by tenocytes and phosphorylation of IRS-1 and ERK-1/2. Both apoptosis and cellular inflammation were absent at all time points. Conclusion. In this animal model, early tendinosis was associated with local stimulation of tenocytes rather than with extrinsic inflammation or apoptosis. Our data suggest a role for IGF-1 in the load-induced tenocyte responses during the pathogenesis of overuse tendon disorders.

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Neovascularization and Pain in Abnormal Patellar Tendons of Active Jumping Athletes

Abstract: This study indicates that the presence of neovascularization in abnormal patellar tendons is associated with greater tendon pain compared with abnormal tendons without neovascularization in active jumping athletes.

Cited by 88 publications

References 9 publications

Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis

Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis

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Tenocyte responses to mechanical loading in vivo: A role for local insulin‐like growth factor 1 signaling in early tendinosis in rats

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