The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study

Am J Sports Med. 2007 Oct;35(10):1696-701. doi: 10.1177/0363546507303116. Epub 2007 Jun 8.


Background: Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy.

Hypothesis: Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment.

Study design: Cohort study (prognosis); Level of evidence, 2.

Methods: Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale).

Results: Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r=.19, P=.131) and VISA-A score (r=-.23, P=.074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r=.43, P<.001) and VISA-A score (r=-.46, P<.001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline.

Conclusion: Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.

Publication types

  • Validation Study

MeSH terms

  • Achilles Tendon / blood supply
  • Achilles Tendon / diagnostic imaging*
  • Adult
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnostic imaging
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Tendinopathy / diagnostic imaging*
  • Ultrasonography, Doppler / methods*