Poor association between tendon structure and self-reported symptoms following conservative management in active soldiers with mid-portion Achilles tendinopathy

Abstract

IntroductionMid-portion Achilles tendinopathy (mid-AT) is currently the preferred term for persistent Achilles tendon pain, defined as located 2–7 cm proximal to the calcaneus, and with loss of function related to mechanical loading. Histologically, mid-AT is considered to represent a degenerative condition. Therefore, monitoring of tendon structure additional to pain and function may be warranted, to prevent progression of degeneration or even tendon rupture. The aim of this study was to determine the association between pain and function, relative to the Achilles tendon structure, in soldiers treated with a conservative programme for mid-AT.MethodsA total of 40 soldiers (40 unilateral symptomatic tendons) were included in this study. Pain and function were evaluated with the Victorian Institute of Sports Assessment -Achilles (VISA-A) questionnaire. Tendon structure was quantified using ultrasound tissue characterisation (UTC). We quantified both the Achilles tendon mid-portion (2–7 cm) and the area of maximum degeneration (AoMD) within the tendon mid-portion. VISA-A and UTC measurements were taken at baseline and after 26 weeks of follow-up. Spearman’s rho was used to determine the correlation between VISA-A and UTC. Correlations were calculated for baseline, follow-up and change score values.ResultsNegligible correlations were found for all analyses, ranging from −0.173 to 0.166 between mid-portion tendon structure and VISA-A, and from −0.137 to 0.150 between AoMD and VISA-A. While VISA-A scores improved, on average, from 59.4 points at baseline to 93.5 points at follow-up, no detectable improvement in aligned fibrillar structure was observed in our population.ConclusionPain and function are poorly associated with Achilles tendon structure in soldiers treated with a conservative programme for mid-AT. Therefore, we advise clinicians to use great caution in communicating relationships between both clinical entities.Trial registration numberNL69527.028.19.

Victorian Institute of Sport Assessment—Achilles thresholds for minimal important change and return to presymptom activity level in active soldiers with mid-portion Achilles tendinopathy

“…The 26-week conservative treatment programme used in this study has been published in detail 16. In short, this programme consisted of: patient education;2 focused extracorporeal shockwave therapy (four weekly sessions during the first 4 weeks); an individualised exercise programme on a stair climber or cross-trainer (at least two weekly sessions during the first 8 weeks); followed by a return to running programme (up to three weekly sessions from week 8 to 26) 16…”

Prognostic value of ultrasound tissue characterisation for a recurrence of mid-portion Achilles tendinopathy in military service members: a prospective cohort study

“…2 10 12 Ultrasound tissue characterisation (UTC) is an imaging modality that can quantify the AT structure into four echo types (I-IV), discriminating aligned fibrillar structure (echo types I+II) from disorganised tendon structure (echo types III+IV). 13 Growing evidence indicates that AT structure is poorly associated with self-reported symptoms, [14][15][16] as measured with the Victorian Institute of Sports Assessment-Achilles (VISA-A) Questionnaire. 17 Yet, UTC has been found to be able to discriminate symptomatic from asymptomatic ATs, using a threshold for aligned fibrillar structure.…”

“…The UTC scans were collected and processed according to a standardised protocol that showed excellent intrarater and inter-rater reliability in the same patient group used for this study. 20 Post-treatment UTC scans from our previous study 14 were used as baseline measurements for the current study. A single examiner in UTC (MAP) collected these scans.…”

“…All patients underwent a conservative treatment programme 14 and were evaluated directly post-treatment and after 1 year of follow-up. The post-treatment measurements for this study consisted of a written VISA-A Questionnaire followed by a UTC examination.…”