The Microvascular Volume of the Achilles Tendon Is Increased in Patients With Tendinopathy at Rest and After a 1-Hour Treadmill Run

Pingel, Jessica; Harrison, Adrian P.; Simonsen, Lene; Suetta, Charlotte; Bülow, Jens; Langberg, Henning

doi:10.1177/0363546513498988

Cited by 38 publications

(58 citation statements)

References 55 publications

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“…This is consistent with other studies that have reported a short-term response in hydration level using off-resonance saturation MRI, 90 tendon volume and intratendinous signal on MRI, 84 and microvascular volume on real-time, harmonic, contrast-enhanced ultrasound 71 in response to load. Of interest is that these studies reported an altered response in tendinopathic tendons.…”

Section: Can Imaging Predict the Onset Of Pain Or Clinical Outcome?supporting

confidence: 93%

“…Of interest is that these studies reported an altered response in tendinopathic tendons. 39,71,79 These new imaging modalities may provide insight into how tendons respond to load. There is overwhelming evidence that structural disorganization predates the development of symptoms and tendon rupture.…”

Section: Can Imaging Predict the Onset Of Pain Or Clinical Outcome?mentioning

confidence: 99%

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Tendinopathy: Is Imaging Telling Us the Entire Story?

Docking¹,

Ooi²,

Connell³

2015

Journal of Orthopaedic & Sports Physical Therapy

149

132

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Synopsis Tendinopathy is frequently associated with structural disorganization within the tendon. As such, the clinical use of ultrasound and magnetic resonance imaging for tendinopathy has been the focus of numerous academic studies and clinical discussions. However, similar to other musculoskeletal conditions (osteoarthritis and intervertebral disc degeneration), there is no direct link between tendon structural disorganization and clinical symptoms, with findings on imaging potentially creating a confusing clinical picture. While imaging shows the presence and extent of structural changes within the tendon, the clinical interpretation of the images requires context in regard to the features of pain and the aggravating loads. This review will critically evaluate studies that have investigated the accuracy and sensitivity of imaging in the detection of clinical tendinopathy and the methodological issues associated with these studies (subject selection, lack of a robust gold standard, reliance on subjective measures). The advent of new imaging modalities allowing for the quantification of tendon structure or mechanical properties has allowed new critical insight into tendon pathology. A strength of these novel modalities is the ability to quantify properties of the tendon. Research utilizing ultrasound tissue characterization and sonoelastography will be discussed. This narrative review will also attempt to synthesize current research on whether imaging can predict the onset of pain or clinical outcome, the role of monitoring tendon structure during rehabilitation (ie, does tendon structure need to improve to get a positive clinical outcome?), and future directions for research, and to propose the clinical role of imaging in tendinopathy. J Orthop Sports Phys Ther 2015;45(11):842–852. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5880

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Section: Can Imaging Predict the Onset Of Pain Or Clinical Outcome?supporting

confidence: 93%

Section: Can Imaging Predict the Onset Of Pain Or Clinical Outcome?mentioning

confidence: 99%

Tendinopathy: Is Imaging Telling Us the Entire Story?

Docking¹,

Ooi²,

Connell³

2015

Journal of Orthopaedic & Sports Physical Therapy

149

132

View full text Add to dashboard Cite

show abstract

“…Several studies have identified vascular hyperplasia in painful tendons and degenerative processes resulting from sports activity [29, 30]. These findings supported the results of clinical studies using color Doppler examination simultaneously with ultrasonography that showed a neovascularization in areas with tendon injury [31, 32]. Normally, avascular tendon tissue becomes hypervascularized during tendinopathy, which supported a key role for VEGF-KDR signals in the pathological angiogenesis in tendinopathy, because VEGF stimulate endothelial cells and vessels to invade hypovascularized tendon areas [12, 13].…”

Section: Discussionsupporting

confidence: 66%

Vascular Endothelial Growth Factor Receptor-2 Polymorphisms Have Protective Effect against the Development of Tendinopathy in Volleyball Athletes

et al. 2016

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The aim of the study was to investigate whether genetic variants in VEGF and KDR genes can be correlated with susceptibility of tendinopathy in volleyball athletes. This study was conducted at the Brazilian Volleyball Federation, and comprised 179 volleyball athletes: 88 had a confirmed diagnosis of tendinopathy (cases), whereas 91 had no evidence of the disease (controls). The VEGF (-2578C>A, -460T>C and +936C>T) and KDR (-604C>T, 1192G>A and 1719T>A) polymorphisms were determined by TaqMan real-time polymerase chain reaction. The odds ratio (OR) with their 95% confidence intervals (CI) were calculated using an unconditional logistic regression model. The evaluation of demographic and clinical characteristics revealed the athlete age (P < 0.001), years of practice in volleyball (P < 0.001) and presence of pain (P = 0.001) were risk factors for tendinopathy. KDR 1192 GA and GA + AA genotypes were associated with lower risk of tendinopathy (OR: 0.41, 95% CI: 0.19–0.88 and OR: 0.47, 95% CI: 0.23–0.98, respectively). The KDR (-604C>T, 1192G>A and 1719T>A) haplotypes CGA and CAT were associated with decreased tendinopathy risk (OR: 0.46, 95% CI: 0.21–0.99 and OR: 0.23, 95% CI: 0.07–0.76, respectively). With regards to pain, traumatic lesion and away from training due to injury, VEGF and KDR polymorphisms were not associated with clinical symptoms complaints. The present results provide evidence that the KDR polymorphisms were associated with development of tendinopathy, and can contribute to identify new therapeutic targets or personalized training programs to avoid tendinopathy development in athletes.

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“…While no significant differences in baseline and postexercise D* values were observed, this may have been caused by the large variation of estimated values and potentially only a small change in blood velocity. Unlike in healthy Achilles tendon, a US study of symptomatic tendinopathy patients observed only a 75% increase in Achilles tendon blood volume after treadmill running . It has been hypothesized that high baseline blood flow of tendinopathic tendon may cause dilation of blood vessels at baseline, thus preventing the ability to achieve postexercise peak flux and resulting in delayed recovery.…”

Section: Discussionmentioning

confidence: 99%