Ultrasound guided electro-coagulation in patients with chronic non-insertional Achilles tendinopathy: a pilot study

Morten Ilum Boesen ^1*, Soren Torp-Pedersen ¹, Merete Juhl Koenig ¹, Robin Christensen ¹, Hening Langberg ², Per Hölmich ³, Michael Bachmann Nielsen ⁴ and Henning Bliddal ⁵

¹ Parker Institute, Frederiksberg Hospital, Denmark
² Sports Medicine Research Unit, Bispebjerg Hospital, Denmark
³ Orthopaedic Department, Amager Hospital, Denmark
⁴ Diagnostic Unit, Ultrasound Section, Rigshospitalet, Copenhagen, Denmark
⁵ Parker Institute, Frederiksberg Hospital, Djibouti

^* To whom correspondence should be addressed. E-mail: morten.boesen{at}get2net.dk.

Accepted 13 June 2006

Abstract

Background: High-resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy (AT). Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated (2 - 4 times).

Objective: This study was conducted to investigate the effect of electro-coagulation of the neovessels on tendon pain and tendon vascularity in patients with chronic AT.

Methods: Colour Doppler ultrasound guided electro-coagulation was used on vessels in the ventral portion of the Achilles tendon in 11 patients (seven men and four women, mean age 41 years) with painful chronic mid-portion Achilles tendinosis. A unipolar coagulation device was used.

Results: One patient dropped out after 2 months (dissatisfied with results). The remaining 10 patients (91%) were satisfied. These ten patients were still satisfied at six-months follow up and had returned to previous level of activity. All 10 patients were "cured" after one treatment. The patient who dropped out received two treatments because of lack of progress. There was significantly reduced pain (Likert pain-scale (0-10)) during activity from a median of 7 (range: 4-10) at baseline to 0 (0-8) at six-months follow-up ( P< 0.0001) and at rest, from 1.5 (1-5) to 0 (0-8) at rest ( P = 0.002). In all patients, vascularisation was unchanged at six-months follow up with no significant change in semi-quantitative or quantitative colour scoring.

Conclusions: Coagulation in the area with vessels entering the tendon appears to be an effective treatment for painful chronic mid-tendineous Achilles tendinopathy. No effect on the intratendinous Doppler activity could be detected, suggesting that the effect is independent of changes in blood flow. We believe that the localisation of hyperaemia still is the key to pathology and for targeting the treatment. One explanation could be that the effect was obtained by a destruction of nerves accompanying the vessels.

Key Words: Achilles tendinopathy, Coagulation therapy, Colour Doppler activity, Treatment, pilot study

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Rees, J. D., Maffulli, N., Cook, J. (2009). Management of Tendinopathy. Am J Sports Med 37: 1855-1867 [Abstract] [Full Text]  
• Sengkerij, P. M., de Vos, R.-J., Weir, A., van Weelde, B. J. G., Tol, J. L. (2009). Interobserver Reliability of Neovascularization Score Using Power Doppler Ultrasonography in Midportion Achilles Tendinopathy. Am J Sports Med 37: 1627-1631 [Abstract] [Full Text]