Introduction:
It 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.
Ultrasonographic 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.
Ultrasonography has no added value:
Chronic 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.
This 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.
A PRP injection is not effective for chronic Achilles tendon injuries:
Injections 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.http://repub.eur.nl/res/pub/20721/1009200_Vos%2C%20Robert%20Johannes%20de.pdf
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