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Prognostic value of ultrasound tissue characterisation for a recurrence of mid- portion Achilles tendinopathy in military service members: a prospective cohort study


M A Paantjens, P H Helmhout, F J G Backx, M T A W Martens, E W P Bakker


BMJ Military Health

Publishing detail

PMID: 37709504


Introduction Tendon structure in mid- portion Achilles tendinopathy (mid- AT) appears poorly associated with symptoms. Yet, degenerative tendon changes on imaging have been associated with an increased risk of mid- AT. We aimed to investigate the prognostic value of ultrasound tissue characterisation (UTC) for a mid- AT recurrence in service members reporting to be recovered following standard care. Methods Mid- portion aligned fibrillar structure was quantified post- treatment in 37 participants. Recurrences were determined after 1 year of follow- up, based on self- perceived recurrence (yes/no) combined with a decrease in post- treatment Victorian Institute of Sports AssessmentAchilles score of at least the minimal important change of 7 points. Receiver operating characteristic curve analyses were used to determine a threshold for dichotomisation of outcomes for aligned fibrillar structure (normal representation/under- representation). Using multivariable logistic regression, the association between a mid- AT recurrence (yes/no) and the dichotomised aligned fibrillar structure was determined. Results Eight participants (22%) experienced a recurrence. The threshold for aligned fibrillar structure was set at 73.2% (95% CI: 69.4% to 77.8%) according to Youden’s index. Values below this threshold were significantly associated with a mid- AT recurrence (odds ratio (OR) 9.7, 95% CI: 1.007 to 93.185). The OR for a mid- AT recurrence was 1.1 (95% CI: 1.002 to 1.150) for each additional month of symptom duration. The explained variance of our multivariable logistic regression model was 0.423; symptom duration appeared to be a better predictor than aligned fibrillar structure. Conclusions This study identified mid- portion aligned f ibrillar structure and symptom duration as potential prognostic factors for a mid- AT recurrence in military service members. The threshold for aligned fibrillar structure of 73.2% can guide preventative interventions (eg, training load adjustments or additional tendon load programmes) aiming to improve tendon structure to minimise the future recurrence risk. Trial registration number, file number ToetsingOnline NL69527.028.19

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