Paantjens M A, Helmhout P H, Backx F J G, Martens M T A W, Bakker E W P
Sports Medicine Centre, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands.
BMJ Mil Health. 2025 Jan 28;171(1):26-32. doi: 10.1136/military-2023-002521.
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.
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 Assessment-Achilles 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.
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.
This study identified mid-portion aligned fibrillar 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.
https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm, file number ToetsingOnline NL69527.028.19.
跟腱中部肌腱病（mid-AT）的肌腱结构似乎与症状关联不大。然而，影像学上的肌腱退变改变与mid-AT风险增加有关。我们旨在研究超声组织特征化（UTC）对报告经标准治疗后已康复的军人中mid-AT复发的预后价值。
对37名参与者治疗后的跟腱中部排列的纤维结构进行量化。随访1年后根据自我感知的复发情况（是/否）以及治疗后维多利亚运动评估-跟腱评分至少下降7分这一最小有意义变化来确定复发情况。采用受试者工作特征曲线分析来确定排列纤维结构（正常表现/表现不足）结果二分法的阈值。使用多变量逻辑回归确定mid-AT复发（是/否）与二分后的排列纤维结构之间的关联。
8名参与者（22%）出现复发。根据约登指数，排列纤维结构的阈值设定为73.2%（95%置信区间：69.4%至77.8%）。低于该阈值的值与mid-AT复发显著相关（比值比（OR）9.7，95%置信区间：1.007至93.185）。症状持续时间每增加一个月，mid-AT复发的OR为1.1（95%置信区间：1.002至1.150）。我们的多变量逻辑回归模型的解释方差为0.423；症状持续时间似乎比排列纤维结构是更好的预测指标。
本研究确定跟腱中部排列的纤维结构和症状持续时间是军人中mid-AT复发的潜在预后因素。73.2%的排列纤维结构阈值可指导旨在改善肌腱结构以将未来复发风险降至最低的预防性干预措施（如训练负荷调整或额外的肌腱负荷计划）。
https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm，文件编号ToetsingOnline NL69527.028.19。
