Value of Quantitative MRI Parameters in Predicting and Evaluating Clinical Outcome in Conservatively Treated Patients With Chronic Midportion Achilles Tendinopathy: A Prospective Study

J Sci Med Sport. 2017 Jul;20(7):633-637. doi: 10.1016/j.jsams.2017.01.234. Epub 2017 Jan 24.


Objectives: To evaluate whether baseline MRI parameters provide prognostic value for clinical outcome, and to study correlation between MRI parameters and clinical outcome.

Design: Observational prospective cohort study.

Methods: Patients with chronic midportion Achilles tendinopathy were included and performed a 16-week eccentric calf-muscle exercise program. Outcome measurements were the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire and MRI parameters at baseline and after 24 weeks. The following MRI parameters were assessed: tendon volume (Volume), tendon maximum cross-sectional area (CSA), tendon maximum anterior-posterior diameter (AP), and signal intensity (SI). Intra-class correlation coefficients (ICCs) and minimum detectable changes (MDCs) for each parameter were established in a reliability analysis.

Results: Twenty-five patients were included and complete follow-up was achieved in 20 patients. The average VISA-A scores increased significantly with 12.3 points (27.6%). The reliability was fair-good for all MRI-parameters with ICCs>0.50. Average tendon volume and CSA decreased significantly with 0.28cm3 (5.2%) and 4.52mm2 (4.6%) respectively. Other MRI parameters did not change significantly. None of the baseline MRI parameters were univariately associated with VISA-A change after 24 weeks. MRI SI increase over 24 weeks was positively correlated with the VISA-A score improvement (B=0.7, R2=0.490, p=0.02).

Conclusions: Tendon volume and CSA decreased significantly after 24 weeks of conservative treatment. As these differences were within the MDC limits, they could be a result of a measurement error. Furthermore, MRI parameters at baseline did not predict the change in symptoms, and therefore have no added value in providing a prognosis in daily clinical practice.

Keywords: Achilles tendon; Eccentric calf muscle exercise; MRI; Prognosis; Tendinopathy; VISA-A.

Publication types

  • Observational Study

MeSH terms

  • Achilles Tendon / diagnostic imaging*
  • Achilles Tendon / physiopathology
  • Adult
  • Conservative Treatment*
  • Exercise Therapy
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Observer Variation
  • Prognosis
  • Prospective Studies
  • Reproducibility of Results
  • Tendinopathy / diagnostic imaging*
  • Tendinopathy / therapy*