The value of power Doppler ultrasonography in Achilles tendinopathy - A prospective study

Background: Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. Hypothesis: Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). Results: Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r =.195 P =.131) and VISA-A score (r = -.23, P =.074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r =.43, P <.001) and VISA-A score (r = -.46, P <.001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. Conclusion: Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.