Background/Purpose: In prior research, the incidence rate of neovascularization with Achilles tendinopathy ranged between 47-88% of cases. The purpose of this study was to identify the incidence rate of neovascularization in individuals with midportion Achilles tendinopathy, and to examine if there were differences in tendon structure, hopping performance, and symptom severity based on the presence or absence of neovessels.

Methods: Eighty-three participants (41 females) with a mean ± SD age of 48 ± 12 years, and BMI of 28 ± 5 with midportion Achilles tendinopathy were recruited. A standardized clinical examination confirmed the diagnosis of midportion Achilles tendinopathy. Tendon morphology was examined with diagnostic ultrasound to measure thickness and cross-sectional area (CSA) at the thickest free portion of the tendon. Power Doppler assessed whether neovessels were present within the tendon. Functional performance was measured with a single-leg hopping task and the plyometric quotient was used for analysis. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Numeric Pain Rating Scale (NPRS) quantified the symptom severity. Participants with and without neovascularization were separated into groups. The differences between groups were assessed with independent t-tests.

Results: On the side with Achilles tendinopathy, neovascularization occurred in 28/83 (34%) of participants. The group with neovascularization, had a significantly greater degree of tendon thickness with a median (interquartile range [IQR]) of 0.3 (0.2-0.4) cm compared to 0.1 (0.1-0.2) cm in the group without neovascularization. The neovascularization group also had a greater CSA (mean ± SD 1.2 ± 0.4 cm²) compared to those without neovascularization (mean ± SD 0.7 ± 0.3 cm²). Those with neovascularization had worse jumping performance (plyometric quotient mean ± SD 0.3 ± 0.2) than those without neovascularization (mean ± SD 0.3=5 ± 0.1). There were no differences were observed in pain with hopping [present, mean ± SD3.7 ± 2.7; absent 2.7 ± 2.3)] or on the VISA-A [present, mean ± SD 48.1 (3.2); absent, 53.0 (2.5)].

Conclusion: Patients with Achilles tendinopathy and neovascularization had reduced jumping performance and worse tendon structure but similar symptom severity as those without neovascularization. Additional research is needed to understand the impact of neovascularization in response to treatment. Neovessels identified through power Doppler ultrasound may assist clinicians in diagnosing the stage of tendinopathy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inferior-tendon-structure-and-function-seen-in-patients-with-achilles-tendinopathy-and-neovascularization-of-the-achilles-tendon/