Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
Am J Sports Med. 2018 Mar;46(4):947-954. doi: 10.1177/0363546517750854. Epub 2018 Jan 26.
Several risk factors have been suggested in the development of Achilles tendinopathy, but large-scale prospective studies are limited.
To investigate the role of the vascular response to activity of the Achilles tendon, tendon thickness, ultrasound tissue characterization (UTC) of tendon structure, and foot posture as possible risk factors in the development of Achilles tendinopathy.
Cohort study; Level of evidence, 2.
The study began with 351 first-year students at Ghent University. After 51 students were excluded, 300 were tested in the academic years 2013-2014 and 2014-2015 and were followed prospectively for 2 consecutive years by use of a multilevel registration method. Of those, 250 students were included in the statistical analysis. At baseline, foot posture index and UTC were investigated bilaterally. Blood flow and tendon thickness were measured before and after a running activity. Cox regression analyses were performed to identify significant contributors to the development of Achilles tendinopathy.
During the 2-year follow-up, 27 of the included 250 participants developed Achilles tendinopathy (11%). Significant predictive effects were found for female sex and blood flow response after running ( P = .022 and P = .019, respectively). The risk of developing Achilles tendinopathy increased if the blood flow increase after running was reduced, regardless of sex, foot pronation, and timing of flow measurements. The model had a predictive accuracy of 81.5% regarding the development of Achilles tendinopathy, with a specificity of 85.0% and a sensitivity of 50.0%.
This prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy. UTC of tendon structure, Achilles tendon thickness, and foot posture did not significantly contribute to the prediction of Achilles tendinopathy. A general evaluation of tendon structure by UTC, measurement of tendon thickness, or determination of the foot posture index will not allow clinicians to identify patients at risk for developing Achilles tendinopathy. Furthermore, it may be possible to improve blood flow after activity by using noninvasive techniques (such as prostaglandins, compression stockings, heat, massage, and vibration techniques). These techniques may be useful in the prevention and management of Achilles tendinopathy, but further research is needed.
已有多项研究指出，多种风险因素可能与跟腱腱病的发生有关，但大规模前瞻性研究仍较为有限。
旨在探讨跟腱活动时的血管反应、跟腱厚度、超声组织特征（UTC）及足弓形态作为跟腱腱病发生的可能危险因素的作用。
队列研究；证据等级，2 级。
该研究以根特大学的 351 名一年级学生为研究对象。排除 51 名学生后，300 名学生于 2013-2014 学年和 2014-2015 学年接受了检测，并采用多级登记法进行了连续 2 年的前瞻性随访。其中，250 名学生纳入了统计分析。在基线时，双侧均进行了足弓形态指数和 UTC 检查。在跑步前和跑步后测量了血流和跟腱厚度。采用 Cox 回归分析识别跟腱腱病发生的显著影响因素。
在 2 年的随访过程中，250 名纳入患者中有 27 名（11%）发生了跟腱腱病。女性和跑步后血流反应是显著的预测因素（P =.022 和 P =.019）。无论性别、足旋前和血流测量时间如何，如果跑步后血流增加减少，则发生跟腱腱病的风险增加。该模型对跟腱腱病发生的预测准确率为 81.5%，特异性为 85.0%，敏感性为 50.0%。
本前瞻性研究发现，女性和跑步后血流反应减少均为跟腱腱病发生的显著危险因素。UTC 对肌腱结构、跟腱厚度和足弓形态的评估均未显著增加跟腱腱病的预测价值。因此，UTC 一般评估肌腱结构、测量跟腱厚度或确定足弓形态指数并不能帮助临床医生识别发生跟腱腱病的高危患者。此外，可能可以通过非侵入性技术（如前列腺素、压缩袜、热、按摩和振动技术）改善活动后的血流。这些技术可能有助于跟腱腱病的预防和管理，但仍需要进一步的研究。
