ORIGINAL ARTICLE

Intermittent KoldBlue cryotherapy of 3x10 min changes mid-portion Achilles tendon microcirculation

Karsten Knobloch^*, Ruth Grasemann^*, Marcus Spies, Peter M Vogt

Sports Traumatology of the Hand and Wrist, Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany

Correspondence to:
Dr K Knobloch
Sports Traumatology of the Hand and Wrist, Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; kknobi{at}yahoo.com

Background: Neovascularisation and microcirculatory changes have been reported in Achilles tendinopathy. Cryotherapy and compression, as part of a rest, ice, compression and elevation regimen, are shown to decrease pain and improve function. However, the microcirculatory changes following a given dosage of cryotherapy on mid-portion Achilles tendon remain unclear.

Study design: Prospective clinical cohort study, level of evidence 2.

Methods: 30 people (12 males, 33 (SD 12) years, body mass index 25.6 (5.3) kg/m²) were included in the cohort. 3x10 min KoldBlue ankle-cooling bandages were applied and microcirculation of Achilles tendon mid-portion was real-time and continuously assessed using a laser-Doppler-spectrophotometry system (O2C, Germany).

Results: Superficial capillary blood flow was reduced from 42 to 6, 5 and 3 relative units (rU) in the first, second and third cryotherapy periods, respectively (–65%, p = 0.001), with no significant capillary hyperaemia. Deep capillary tendon blood flow was reduced from 180 to 82, 53 and 52 rU (–71%, p = 0.001) within 6–9 min of application without hyperaemia. Superficial tendon oxygen saturation dropped significantly from 43% to 26%, 18% and 11% (p = 0.001) after repetitive cryotherapy, with persisting increase of tendon oxygenation during rewarming (51%, 49% and 54%, p = 0.077) up to 27% of the baseline level. At 8 mm tendon depth, cryotherapy preserved local oxygenation. Relative postcapillary venous tendon filling pressures were favourably reduced from 41 (11) to 31, 28 and 26 rU (–36%, p = 0.001) superficially and from 56 (11) to 45, 46 and 48 rU (–18%, p = 0.001) in deep capillary blood flow during cryotherapy, facilitating capillary venous clearance.

Conclusion: Intermittent cryotherapy of 3x10 min significantly decreases local Achilles tendon mid-portion capillary blood flow by 71%. Within 2 min of rewarming, tendon oxygen saturation is re-established following cryotherapy. Postcapillary venous filling pressures are reduced during cryotherapy, favouring capillary venous outflow of the healthy Achilles tendon.

Abbreviations: AU, arbitrary units; FAOS, Foot and Ankle Outcome Score; rU, relative units, rHb-haemoglobin relative units

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