Year: 2010
Type: dissertation
Abstract: Introduction:\\nIt is estimated that 30-50% of sports injuries are caused by tendon disorders. Chronic midportion Achilles tendinopathy is a frequent problem, particularly occurring in athletes but also affecting inactive people. Diagnosis is made based on clinical findings and currently the term Achilles tendinopathy is preferred. Until know, we assumed that a reduced tissue repair mechanism with tendon tissue degeneration is the cause of the persistence of symptoms. \\nUltrasonographic appearance of tendinopathy is characterised by a reduced tendon fibre structure and increased blood flow to the tendon (neovascularisation). Until recently, the prognostic value of ultrasound disorders was in this patient group. \\n\\nUltrasonography has no added value:\\nChronic Achilles tendinopathy frequently leads to a reduction of sports activities and can even be career-threatening for an athlete. Currently, a standardised exercise program of 12 weeks is the first choice of treatment. The current conservative and surgical treatments often lead to an unsatisfactory result. \\nThis dissertation shows that the ultrasonographic tendon structure can be measured with a high reliability, using a novel innovative technique which was already validated in veterinary medicine. We also found that determining the degree of neovascularisation could be measured with an excellent reliability. There was a clear difference in ultrasonographic tendon structure and neovascularisation between healthy subjects and patients with tendinopathy. However, in follow-up studies the degree of tendon structure disorganisation and neovascularisation could not predict outcome after treatment. This means that ultrasound examination has no added value. \\n\\nA PRP injection is not effective for chronic Achilles tendon injuries:\\nInjections with autologous growth factors, derived from autologous blood, are widely used in the United States. An increased concentration of blood platelets can be obtained, also known as Platelet-rich plasma (PRP). The promising results of PRP gained worldwide attention in the treatment of tendon injuries. In a systematic review of the literature, however, we found only limited evidence for the effect of PRP injections in the treatment of chronic tendinopathies. Therefore we conducted a prospective double-blind placebo-controlled randomised trial. This study showed that there is no added value of a PRP injection to the current usual care. The results of this study are published in JAMA, one of the leading scientific journals. This has led to major global debates about the usefulness of these injections.
Author: Robert‐Jan de Vos
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W177530086