Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy

Yi Cheng, Jian Zhang, Yehua Cai, Yi Cheng, Jian Zhang, Yehua Cai

Abstract

Introduction. The aim of this study was to investigate the utility of ultrasonography (US) for predicting and assessing the effectiveness of extracorporeal shock wave therapy (ESWT) in insertional Achilles tendinopathy (IAT). Methods. A total of 42 patients with an established diagnosis of chronic IAT were examined by US before ESWT and at 4 weeks and 12 weeks after ESWT. The thickness and cross-sectional area (CSA) of the Achilles tendon, size of calcific plaques, tendon structure score, and neovascularization score were measured at each time point. Results. After therapy, Victorian Institute of Sport Assessment-Achilles (VISA-A) scores increased significantly, and the size of calcific plaques decreased (P < 0.05). Neovascularization scores increased at the 4th week and then decreased at the 12th week (P < 0.05). The thickness, CSA, and structure of the Achilles tendon did not change. Variables observed by US at baseline were not associated with changes in VISA-A scores at follow-up. However, the changes in calcific plaque size and neovascularization scores were related to the improvement of VISA-A scores between pre- and posttherapy (P < 0.01). Conclusion. Ultrasonography can reveal some changes in the insertion of the Achilles tendon after ESWT, but the outcome of ESWT in IAT cannot be predicted by the variables observed by US.

Conflict of interest statement

The authors confirm that there is no conflict of interests associated with this publication and there has been no financial support for this work that could have influenced its outcome.

Figures

Figure 1
Figure 1
Transverse sonograms show 4-grade scale of tendon structure (outline of Achilles tendon traced by dotted line). (a) Grade 0—normal structure (homogenous echogenicity). (b) Grade 1—light structural changes (discrete hypoechogenic areas). (c) Grade 2—moderate structural changes (some well-defined hypoechogenic areas). (d) Grade 3—severe structural changes (extended hypoechogenic areas).
Figure 2
Figure 2
(a) Transverse sonogram shows plentiful calcific plaques (arrows) in the insertion of the Achilles tendon before therapy (outline of Achilles tendon traced by dotted line). (b) The calcific plaques reduced by the 4th week after therapy.
Figure 3
Figure 3
(a) Color Doppler shows no vessels in the insertion of the Achilles tendon before therapy. (b) There was neovascularization at the 4th week after therapy.
Figure 4
Figure 4
Changes in the VISA-A scores of patients with and without neovascularization at baseline, week 4, and week 12.
Figure 5
Figure 5
Changes in the VISA-A scores of patients with and without calcific plaques at baseline, week 4, and week 12.

References

    1. Maffulli N., Wong J., Almekinders L. C. Types and epidemiology of tendinopathy. Clinics in Sports Medicine. 2003;22(4):675–692. doi: 10.1016/S0278-5919(03)00004-8.
    1. Furia J. P. High-energy extracorporeal shock wave therapy as a treatment for insertional achilles tendinopathy. The American Journal of Sports Medicine. 2006;34(5):733–740. doi: 10.1177/0363546505281810.
    1. Rompe J. D., Furia J., Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy: a randomized, controlled trial. The Journal of Bone and Joint Surgery—Series A. 2008;90(1):52–61. doi: 10.2106/jbjs.f.01494.
    1. Fridman R., Cain J. D., Weil L., Jr., Weil L., Sr. Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study. Journal of the American Podiatric Medical Association. 2008;98(6):466–468. doi: 10.7547/0980466.
    1. Saxena A., Ramdath S., O'Halloran P., Gerdesmeyer L., Gollwitzer H. Extra-corporeal pulsed-activated therapy (‘EPAT’ sound wave) for achilles tendinopathy: A Prospective Study. The Journal of Foot and Ankle Surgery. 2011;50(3):315–319. doi: 10.1053/j.jfas.2011.01.003.
    1. Vulpiani M. C., Trischitta D., Trovato P., Vetrano M., Ferretti A. Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study. The Journal of Sports Medicine and Physical Fitness. 2009;49(2):171–176.
    1. Leung J. L. Y., Griffith J. F. Sonography of chronic Achilles tendinopathy: a case-control study. Journal of Clinical Ultrasound. 2008;36(1):27–32. doi: 10.1002/jcu.20388.
    1. Yang X., Pugh N. D., Coleman D. P., Nokes L. D. M. Are Doppler studies a useful method of assessing neovascularization in human Achilles tendinopathy? A systematic review and suggestions for optimizing machine settings. Journal of Medical Engineering and Technology. 2010;34(7-8):365–372. doi: 10.3109/03091902.2010.497892.
    1. Knobloch K. The use of a neovascularization score to predict clinical severity in Achilles tendinopathy. The American Journal of Sports Medicine. 2008;36(2):395–397. doi: 10.1177/0363546507312378.
    1. de Vos R.-J., Weir A., Cobben L. P. J., Tol J. L. The value of power doppler ultrasonography in Achilles tendinopathy: a prospective study. The American Journal of Sports Medicine. 2007;35(10):1696–1701. doi: 10.1177/0363546507303116.
    1. Ooi C. C., Schneider M. E., Malliaras P., Chadwick M., Connell D. A. Diagnostic Performance of axial-strain sonoelastography in confirming clinically diagnosed achilles tendinopathy: comparison with B-mode ultrasound and color doppler imaging. Ultrasound in Medicine & Biology. 2015;41(1):15–25. doi: 10.1016/j.ultrasmedbio.2014.08.019.
    1. Sunding K., Fahlström M., Werner S., Forssblad M., Willberg L. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(6):1988–1996. doi: 10.1007/s00167-014-3270-4.
    1. Öhberg L., Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: Pilot study of a new treatment. British Journal of Sports Medicine. 2002;36(3):173–175. doi: 10.1136/bjsm.36.3.173.
    1. Robinson J. M., Cook J. L., Purdam C., et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. British Journal of Sports Medicine. 2001;35(5):335–341. doi: 10.1136/bjsm.35.5.335.
    1. Wang C.-J., Wang F.-S., Yang K. D., et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. Journal of Orthopaedic Research. 2003;21(6):984–989. doi: 10.1016/S0736-0266(03)00104-9.
    1. Waugh C. M., Morrissey D., Jones E., Riley G. P., Langberg H., Screen H. R. C. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy. European Cells and Materials. 2015;29:268–280.
    1. Vetrano M., d'Alessandro F., Torrisi M. R., Ferretti A., Vulpiani M. C., Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surgery, Sports Traumatology, Arthroscopy. 2011;19(12):2159–2168. doi: 10.1007/s00167-011-1534-9.
    1. Chen Y.-J., Wang C.-J., Yang K. D., et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-β1 and IGF-I expression. Journal of Orthopaedic Research. 2004;22(4):854–861. doi: 10.1016/j.orthres.2003.10.013.
    1. Bosch G., de Mos M., van Binsbergen R. V., van Schie H. T. M., van de Lest C. H. A., van Weeren P. R. The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Veterinary Journal. 2009;41(4):335–341. doi: 10.2746/042516409X370766.
    1. Bannuru R. R., Flavin N. E., Vaysbrot E., Harvey W., McAlindon T. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Annals of Internal Medicine. 2014;160(8):542–549. doi: 10.7326/m13-1982.
    1. Wang C.-J., Ko J.-Y., Chan Y.-S., Weng L.-H., Hsu S.-L. Extracorporeal shockwave for chronic patellar tendinopathy. American Journal of Sports Medicine. 2007;35(6):972–978. doi: 10.1177/0363546506298109.
    1. Movin T., Gad A., Reinholt F. P., Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthopaedica Scandinavica. 1997;68(2):170–175. doi: 10.3109/17453679709004002.

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