Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score

S F E Praet; J H Ong; C Purdam; M Welvaert; G Lovell; L Dixon; J E Gaida; J Anglim; S Manzanero; N Vlahovich; D Hughes; G Waddington

doi:10.1016/j.jsams.2018.05.013

Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score

J Sci Med Sport. 2018 Dec;21(12):1185-1191. doi: 10.1016/j.jsams.2018.05.013. Epub 2018 May 15.

Authors

S F E Praet¹, J H Ong², C Purdam³, M Welvaert⁴, G Lovell², L Dixon³, J E Gaida⁵, J Anglim², S Manzanero⁴, N Vlahovich², D Hughes², G Waddington⁴

Affiliations

¹ Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia. Electronic address: stephan.praet@canberra.edu.au.
² Department of Sport Medicine, Australian Institute of Sport, Australia.
³ Department of Physiotherapy, Australian Institute of Sport, Australia.
⁴ Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
⁵ University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia; Discipline of Physiotherapy, University of Canberra, Australia.

PMID: 29789266
DOI: 10.1016/j.jsams.2018.05.013

Abstract

Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes.

Design: Cross-sectional study.

Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons.

Results: There was a significant association between VISA-A and MV (B=-5.3, 95%CI=[-8.5; -2.0], P=0.0004), and between MV and symptom duration (B=-1.7, 95%CI=[-3.2; -5.0], P=0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t=3.46, 95%CI=[0.27; 1.03], P<0.005).

Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.

Keywords: Achilles tendon; Contrast agent; Doppler ultrasound; Medical imaging; Microvessels; Sensory threshold.

MeSH terms

Achilles Tendon / blood supply*
Achilles Tendon / diagnostic imaging*
Adult
Cross-Sectional Studies
Female
Humans
Male
Microvessels / diagnostic imaging*
Middle Aged
Randomized Controlled Trials as Topic
Tendinopathy / diagnostic imaging*
Ultrasonography*