Neovascularisation in chronic tendon injuries detected with colour Doppler ultrasound in horse and man: implications for research and treatment

Abstract

Recent research on chronic painful Achilles tendons in humans using ultrasonography and immunohistochemistry, has demonstrated an association between neurovascular ingrowth and tendon pain. In horses, chronic debilitating tendon conditions are well-known to be very difficult to treat, and the background to impaired function and pain is not scientifically clarified. In a collaborative research project between the Sports Medicine Unit in Umeå and Strömsholm Equine Hospital, grey-scale ultrasonography (US) and colour Doppler (CD) examination were performed in ten horses with chronic tendon injuries (>3 months) and a control group of six healthy and asymptomatic horses. In all symptomatic tendons, but not in any of the tendons in the control group, neovessels were seen in the area with structural tendon changes. The neovessels found in the horse tendons looked similar to what has recently been presented in human Achilles tendons. These findings motivate evaluation of the same treatment, a sclerosing injection that was demonstrated recently to give promising results in the treatment of chronic Achilles tendon injuries (tendinosis) in humans.

Desmopathy of the front proximal suspensory ligament in conjunction with a metacarpal cortical fracture in a horse: A multi-modality imaging study

“…Furthermore, the lesion-related loss of echogenicity has to be assigned correctly as being either a hematoma, edema or granulation tissue or whether these areas represent the physiological embedded muscle-fat-bundles (Nagy und Dyson 2012, Werpy et al 2012, Werpy et al 2013. Doppler ultrasonography may distinguish between different stages of highly vascularized granulation tissue in non-cadaver limbs (Kristoffersen et al 2005). MRI allowed visualization of a unilateral involvement of the muscle-fat-bundle in the morphological destruction of the PSL, the thickening of the dorsal fibrous part of the medial lobe and the thickening of the medial and palmar cortex of the third metacarpal bone.…”

Effects of Autologous Conditioned Plasma® (ACP) on the healing of surgically induced core lesions in equine superficial digital flexor tendon

“…There is a general consensus that normal equine tendons present no detectable intratendinous blood flow when evaluated with color or power Doppler ultrasound (Bosch et al 2011, Kristoffersen et al 2005. The role of persistent intra-tendinous vascularization is seen controversial in the literature.…”

“…The role of persistent intra-tendinous vascularization is seen controversial in the literature. Traditionally, persistent vascularization has been interpreted as a sign of inadequate healing and incomplete repair (Kristoffersen et al 2005, Murata et al 2012), but it is not clear in the literature for how many months the vascularization should be visible, so that it can be called persistent. On the contrary, Bosch and others (2011a) reported that 23 weeks after intra-tendinous PRP treatment, the PRP treated tendons presented a higher CDU vascularization score than saline treated tendons.…”

“…Estrada et al Pferdeheilkunde 30 (2014) 640 models (Bosch et al 2010, Bosch et al 2011a, Bosch et al 2011b, it seems that PRP has a more profound effect on tendon healing than ACP without anticoagulant. On the other hand, even though PRP showed several positive effects on tendon healing, it is still questionable if the increased intratendinous vascularization, sulphated GAG content and cellularity found 23 weeks after the first treatment can be interpreted as beneficial, since these features have been previously correlated to poor tendon repair (Godwin et al 2012, Kristoffersen et al 2005. Therefore, it is of paramount importance to continue studying the in vivo effect of the different platelet preparations to determine which is more efficient normalizing biomechanical, biochemical and histological parameters towards those levels found in healthy tendons.…”

Intermittent KoldBlue cryotherapy of 3×10 min changes mid-portion Achilles tendon microcirculation

“…4 The Achilles tendon and paratendon microcirculation in healthy athletes differ from patients with either insertional or mid-portion tendinopathy, where capillary blood flow at the point of pain is increased, as determined by laser Doppler flowmetry. 5 In a previous study, using a non-invasive real-time laser Doppler spectrophotometry system on the ankle to detect the microcirculatory effects of combined cryotherapy and compression as achieved by the AIRCAST Cryo/Cuff device (AIRCAST, Summit, NJ, USA), we found the relevant effects on microcirculation of combined cryotherapy and compression to take place within the first 10 min of application during a total 30 min application time.…”