Is Sonographic Assessment of Intratendinous Blood Flow in Achilles Tendinopathy Patients Reliable?

Risch, Lucie; Cassel, Michael; Messerschmidt, Janin; Intziegianni, Konstantina; Fröhlich, Katja; Kopinski, Stephan; Mayer, Frank

doi:10.1055/s-0035-1569286

Cited by 16 publications

(43 citation statements)

References 31 publications

(84 reference statements)

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“…The modified Ohberg score has been applied already in previous investigations for evaluating advanced dynamic flow imaging in Achilles and patellar tendons . Reliability in terms of the clinical assessment of Achilles tendon vascularization using advanced dynamic flow has revealed slightly lower intraobserver (Kendall τ, 0.84–0.92) and only moderate interobserver (Kendall τ, 0.68–0.70) reliability compared with our results.…”

Section: Discussionmentioning

confidence: 99%

“…Sixty‐seven Doppler US videos recorded in a previously conducted investigation were reevaluated for this study. The recordings were acquired in several areas with vascularization throughout the whole left and right Achilles tendons (from the tendon insertion to the musculotendinous junction) of 14 participants with acute or chronic unilateral or bilateral Achilles tendinopathy (mean ± SD of Victorian Institute of Sports Assessment–Achilles score 72 ± 15) .…”

Section: Methodsmentioning

confidence: 99%

“…The recordings were acquired in several areas with vascularization throughout the whole left and right Achilles tendons (from the tendon insertion to the musculotendinous junction) of 14 participants with acute or chronic unilateral or bilateral Achilles tendinopathy (mean ± SD of Victorian Institute of Sports Assessment–Achilles score 72 ± 15) . The presence of Achilles tendinopathy was diagnosed in cases with a positive history of tendon pain and pain on palpation of the tendon, assessed by a sports medicine physician with 4 years of clinical practice and study participation using musculoskeletal US . The participants were recruited from the university outpatient clinic.…”

Section: Methodsmentioning

confidence: 99%

“…The box size of the region of interest (ROI) was 2.0 cm wide and 1.5 cm deep. Each US recording consisted of a video sequence (5 seconds) saved as an audio‐video interleaved file (Figure ) …”

Section: Methodsmentioning

confidence: 99%

“…High‐sensitivity, recently developed broadband Doppler “advanced dynamic flow” with US imaging comparable with the B‐scan quality, color mapping to show the direction of flow, and a higher resolution and frame rate has shown enhanced precision in distinctly depicting and discriminating vessels compared with conventional Doppler US in prenatal vascular imaging . Its applicability and reliability in tendon examinations have been shown recently . However, the reliability of adequate scoring procedures has not been investigated yet.…”

mentioning

confidence: 99%

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Reliability of Evaluating Achilles Tendon Vascularization Assessed With Doppler Ultrasound Advanced Dynamic Flow

Risch

Wochatz

Messerschmidt

et al. 2017

J of Ultrasound Medicine

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Objectives The reliability of quantifying intratendinous vascularization by high‐sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. Methods Three investigators evaluated vascularization in 67 recordings in a test‐retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen κ and Fleiss κ coefficients (absolute), Kendall τ b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland‐Altman analysis (bias and limits of agreement [LoA]). Results Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0–1.5; bias, –1; and LoA, 3–4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0–1.9; bias, 0; and LoA, 3–5 vessels). Conclusions The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Reliability of Evaluating Achilles Tendon Vascularization Assessed With Doppler Ultrasound Advanced Dynamic Flow

Risch

Wochatz

Messerschmidt

et al. 2017

J of Ultrasound Medicine

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Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method?

Vlist

Veen

Oosterom³

et al. 2019

J of Ultrasound Medicine

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Objectives Ultrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0–4+) has higher reliability than a quantified measure of Doppler flow (0–100%). The purpose of this cross‐sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy. Methods Two observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score. Results In total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58–0.91), compared to 0.64 (95% confidence interval, 0.45–0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points. Conclusions The SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcomes the ceiling effect of the modified Öhberg score. Future research should focus on the relationship between the SAQ method and clinical outcomes and use this method to monitor treatment responses.

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Tendon blood flow, angiogenesis, and tendinopathy pathogenesis

Merkel

Hellsten

Magnusson

et al. 2021

Translational Sports Med

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Physical exercise results in a duration and intensity‐dependent vascular response in healthy human tendon. In overused (tendinopathy) and damaged tendon, angiogenic pathways are activated and neovascularization is observed. Whereas no direct relationship exists between the amount of neovessels and degree of tendinopathy symptoms, almost all tendinopathic patients have elevated neovascularization and tendon blood flow, as assessed by Doppler ultrasound methodology. The enhanced flow in tendinopathy can be successfully abolished by heavy resistance training. Already in the early time‐phase of tendinopathy (<3 months), neovascularization in the tendon exists but the causal sequence of vascular, metabolic, nociceptive, and matrix tissue changes in tendon pathology is not fully understood. Nevertheless, existing evidences point at neovascularization being an important component of pathogenesis and may occur already before the development of clinical symptoms in tendinopathy.

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Is Sonographic Assessment of Intratendinous Blood Flow in Achilles Tendinopathy Patients Reliable?

Cited by 16 publications

References 31 publications

Reliability of Evaluating Achilles Tendon Vascularization Assessed With Doppler Ultrasound Advanced Dynamic Flow

Reliability of Evaluating Achilles Tendon Vascularization Assessed With Doppler Ultrasound Advanced Dynamic Flow

Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method?

Tendon blood flow, angiogenesis, and tendinopathy pathogenesis

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