Abstract
Objective: To evaluate the morphological response and healing process after transverse ultrasound guided core biopsies in chronic Achilles tendinosis using serial magnetic resonance imaging (MRI) over a period of one year.
Methods: The study included 10 patients. Six had five transverse core biopsies and were longitudinally evaluated by MRI before the biopsies and then after one week, three months, seven months, and one year. These patients started a three month eccentric training programme one to two weeks after the biopsy. Four "non-biopsied" and untreated patients were used for comparison. The clinical outcome was categorised according to the level of pain and performance.
Results: The MRI one week after the biopsies showed an increase in tendon volume (T1-WI) and mean signal intensity (PD-WI) of 29% and 30% (p = 0.04). During follow up, tendon volume and mean signal intensity gradually decreased. One year after the biopsy, the tendon volume had decreased by 20% and the intratendinous signal by 28% compared with the index MRI (p = 0.04). The untreated patients showed an increase in both tendon volume (39%, p = 0.06) and intratendinous signal (37%, p = 0.14) at the one year follow up. After one year, pain and performance had improved in the treated patients but not the untreated patients.
Conclusion: Five transverse ultrasound guided core biopsies induced a lesion in the diseased Achilles tendon. Alterations during healing such as tendon size and intratendinous signal intensity could be evaluated by MRI. The tendon alterations had decreased one year after the core biopsies.
Full Text
The Full Text of this article is available as a PDF (397.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Alfredson H., Pietilä T., Jonsson P., Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360–366. doi: 10.1177/03635465980260030301. [DOI] [PubMed] [Google Scholar]
- Aström M., Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995 Jul;(316):151–164. [PubMed] [Google Scholar]
- Karjalainen P. T., Ahovuo J., Pihlajamäki H. K., Soila K., Aronen H. J. Postoperative MR imaging and ultrasonography of surgically repaired Achilles tendon ruptures. Acta Radiol. 1996 Sep;37(5):639–646. doi: 10.1177/02841851960373P244. [DOI] [PubMed] [Google Scholar]
- Karjalainen P. T., Aronen H. J., Pihlajamäki H. K., Soila K., Paavonen T., Böstman O. M. Magnetic resonance imaging during healing of surgically repaired Achilles tendon ruptures. Am J Sports Med. 1997 Mar-Apr;25(2):164–171. doi: 10.1177/036354659702500204. [DOI] [PubMed] [Google Scholar]
- Kartus J., Movin T., Papadogiannakis N., Christensen L. R., Lindahl S., Karlsson J. A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med. 2000 Mar-Apr;28(2):218–226. doi: 10.1177/03635465000280021301. [DOI] [PubMed] [Google Scholar]
- Khan K. M., Forster B. B., Robinson J., Cheong Y., Louis L., Maclean L., Taunton J. E. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med. 2003 Apr;37(2):149–153. doi: 10.1136/bjsm.37.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leadbetter W. B. Cell-matrix response in tendon injury. Clin Sports Med. 1992 Jul;11(3):533–578. [PubMed] [Google Scholar]
- Maffulli N., Testa V., Capasso G., Bifulco G., Binfield P. M. Results of percutaneous longitudinal tenotomy for Achilles tendinopathy in middle- and long-distance runners. Am J Sports Med. 1997 Nov-Dec;25(6):835–840. doi: 10.1177/036354659702500618. [DOI] [PubMed] [Google Scholar]
- Maffulli N., Thorpe A. P., Smith E. W. Magnetic resonance imaging after operative repair of achilles tendon rupture. Scand J Med Sci Sports. 2001 Jun;11(3):156–162. [PubMed] [Google Scholar]
- Movin T., Guntner P., Gad A., Rolf C. Ultrasonography-guided percutaneous core biopsy in Achilles tendon disorder. Scand J Med Sci Sports. 1997 Aug;7(4):244–248. doi: 10.1111/j.1600-0838.1997.tb00147.x. [DOI] [PubMed] [Google Scholar]
- Movin T. Tendon tissue sampling. Scand J Med Sci Sports. 2000 Dec;10(6):368–371. doi: 10.1034/j.1600-0838.2000.010006368.x. [DOI] [PubMed] [Google Scholar]
- Möller M., Lind K., Movin T., Karlsson J. Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment. Scand J Med Sci Sports. 2002 Feb;12(1):9–16. doi: 10.1034/j.1600-0838.2002.120103.x. [DOI] [PubMed] [Google Scholar]
- Nicolaisen T., Skovgaard D., Kjaer M. Conservative treatment of a partial Achilles tendon rupture with an intratendinous lesion. Scand J Med Sci Sports. 1997 Jun;7(3):191–193. doi: 10.1111/j.1600-0838.1997.tb00138.x. [DOI] [PubMed] [Google Scholar]
- Ohberg Lars, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med. 2002 Jun;36(3):173–177. doi: 10.1136/bjsm.36.3.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rolf C., Movin T. Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int. 1997 Sep;18(9):565–569. doi: 10.1177/107110079701800906. [DOI] [PubMed] [Google Scholar]
- Stanish W. D., Rubinovich R. M., Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986 Jul;(208):65–68. [PubMed] [Google Scholar]
- Testa V., Maffulli N., Capasso G., Bifulco G. Percutaneous longitudinal tenotomy in chronic Achilles tendonitis. Bull Hosp Jt Dis. 1996;54(4):241–244. [PubMed] [Google Scholar]
- Testa Vittorino, Capasso Giovanni, Benazzo Franco, Maffulli Nicola. Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exerc. 2002 Apr;34(4):573–580. doi: 10.1097/00005768-200204000-00002. [DOI] [PubMed] [Google Scholar]