Departments of Radiology, Karolinska Institutet, Clintec, Karolinska University Hospital/Huddinge, 14186 Stockholm, Sweden.
Skeletal Radiol. 2010 May;39(5):435-42. doi: 10.1007/s00256-009-0798-3. Epub 2009 Sep 23.
To evaluate the long-term results following eccentric calf-muscle training in patients with chronic Achilles tendinopathy.
A total of 24 patients with chronic Achilles tendinopathy were included in a study evaluating MRI findings and clinical symptoms before and after 3 months of daily eccentric calf-muscle strength training. Median duration of symptoms was 18 months (range 6-120). Four of the patients did not perform the prescribed treatment for different reasons and were followed for 14 months. The resulting 20 treated patients completed 4.2-year (range 29-58 months) follow up. Tendon volume was evaluated by using 3D seed growing technique and signal abnormalities were visually semi-quantitatively graded. Level of pain and performance was categorized using a questionnaire completed by the patient.
In the symptomatic treated patients, median intensity level of pain decreased from moderate/severe at time of inclusion to mild at follow up (p < 0.05). Median level of performance increased from severe impairment at time of inclusion to normal at follow up (p < 0.05). 12 out of 20 patients had raised intratendinous signal at time of inclusion compared to 2 out of 20 patients at follow up (p < 0.001). Mean tendon-volume measured 6.7 cm(3) (SD 2.0) at time of inclusion and 6.4 cm(3) (SD 2.0) at follow up (p = 0.18). The four symptomatic non-treated tendons did not improve regarding pain, performance, intratendinous signal or tendon volume.
We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients.
评估慢性跟腱腱病患者进行离心性小腿肌肉训练的长期效果。
本研究共纳入 24 例慢性跟腱腱病患者，评估其 MRI 表现和 3 个月日常离心性小腿肌肉力量训练前后的临床症状。症状持续时间中位数为 18 个月（范围 6-120 个月）。4 例患者因各种原因未进行规定的治疗，并随访 14 个月。其余 20 例接受治疗的患者完成了 4.2 年（范围 29-58 个月）的随访。使用 3D 种子生长技术评估肌腱体积，并对信号异常进行视觉半定量分级。采用患者完成的问卷对疼痛程度和功能状态进行分类。
在有症状的治疗患者中，疼痛的平均强度从纳入时的中度/重度降低到随访时的轻度（p<0.05）。功能状态的平均水平从纳入时的严重损伤提高到随访时的正常（p<0.05）。20 例患者中有 12 例在纳入时存在跟腱内高信号，而在随访时只有 2 例（p<0.001）。纳入时平均肌腱体积为 6.7cm3（SD 2.0），随访时为 6.4cm3（SD 2.0）（p=0.18）。4 例有症状但未接受治疗的跟腱在疼痛、功能、跟腱内信号或肌腱体积方面均未改善。
在一项 4.2 年的临床和 MRI 随访中，我们发现与基线检查和 3 个月训练方案后相比，接受大负荷离心性小腿肌肉训练的慢性跟腱腱病患者的疼痛减轻、功能改善和跟腱内信号减少。尽管没有进一步的积极治疗，但在 4.2 年随访时的改善比治疗后即刻更大。这可能表明跟腱腱病患者有良好的长期预后。
