| 1. |
- Alfredson, Håkan, et al.
(författare)
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Ultrasound and doppler-guided artthroscopic shaving for the treatment of patellar tendinopathy/jumper´s knee : biological background and description of method
- 2011
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Ingår i: Anterior knee pain and patellar instability. - London : Springer London. - 9780857295071 ; , s. 367-371
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Bokkapitel (refereegranskat)abstract
- Treatment with ultrasound and Doppler-guided arthroscopic shaving of the region with vessels and nerves outside the dorsal tendon has shown promising clinical results in patients with proximal patellar tendinopathy/Jumper´s knee. The results concerning only a limited patient material has been published in a scientific paper. Results on larger materials are under evaluation for later publication. Proper understanding of the ultrasound and Doppler findings, to enable for a precise and minimal arthroscopic shaving procedure on the dorsal side of the tendon, are cornerstones using this new type of treatment.
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| 2. |
- Sunding, Kerstin, et al.
(författare)
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Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler : using a four-grade scale
- 2016
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 24:6, s. 1988-1996
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In tendon research, using ultrasound (US), studies often refer to tendon thickness, structural abnormalities and neovascularisation. The reliability concerning these measurements and evaluations is seldom reported. The aim of this study was to assess the intra- and inter-observer reliability for quantitative measures (thickness) and qualitative evaluations (structure and neovascularisation) of symptomatic and asymptomatic Achilles and patellar tendons with US and colour Doppler using a modified Öhberg score.METHODS: Twenty-eight consecutive patients with symptomatic and asymptomatic Achilles (n = 27) and patellar tendons (n = 26) were included. Tendon anteroposterior thickness was measured. Tendon structure and neovascularisation were evaluated using a modified Öhberg score. US-images were evaluated twice by four independent observers.RESULTS: Mean thickness for Achilles and patellar tendons was 8.4 mm (±2.0) and 5.5 mm (±1.7), respectively. The reliability for measures of distance was high all over (ICC = 0.963-0.999). A moderate-strong correlation was found between observers concerning evaluation of neovascularisation (r = 0.767-0.992) and poor-moderate correlation concerning evaluation of structural changes (r = 0.379-0.837). Intra-observer reliability was moderate strong for evaluations of both tendon structure (k = 0.537-0.873) and neovascularisation (k = 0.639-0.864).CONCLUSIONS: With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.
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| 3. |
- Sunding, Kerstin, et al.
(författare)
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Sclerosing injections and ultrasound-guided arthroscopicshaving for patellar tendinopathy : good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study
- 2015
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 23:8, s. 2259-2268
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-"Back in full loading activity?" yes or no.RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.
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| 4. |
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| 5. |
- Willberg, Lotta, 1968-
(författare)
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Patellar and Achilles tendinopathy : sclerosing injections and ultrasound guided arthroscopic shaving
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for tendon pain. Immuno-histochemical analyses of biopsies have shown sensory and sympathetic nerves in close relation to the high blood flow outside the tendon. These findings have led to new ideas about development of new treatment methods for chronic painful tendinopathy. In study I, we evaluated the already in use, US-guided sclerosing polidocanol injection treatment of midportion Achilles tendinopathy, using two different concentrations of the substance. This study aimed to find out if there was a faster return to pain-free activity by using the concentration 10 mg/ml compared to the formerly used 5 mg/ml. There were no significant differences in the clinical results between the groups. In study II - Technical note, we aimed to develop a new one-stage surgical treatment method for patellar tendinopathy. This method was based on research concerning the innervation patterns and US and CD findings in patellar tendinopathy/ “jumper’s knee”. Technically we added ultrasound guidance to knee arthroscopy to identify and visualize the region of interest during a surgical shaving procedure. In study III, we tested the newly invented US and CD-guided arthroscopic shaving technique in a pilot study. The short-term clinical results were promising and the majority of the patients returned to pain-free activity after a short rehabilitation period. In study IV, we compared the US and CD-guided artrhroscopic shaving method with the already in use sclerosing polidocanol injection treatment in a randomized study. At short-term follow-up, the patients treated with US and CD-guided arthroscopic shaving had significantly less pain during rest and activity, were significantly more satisfied with the treatment, and had a faster return to sports, compared to the patients in the sclerosing injection group. There were no complications. In study V, at longer-term followup (endpoint 46 months) there was a significant decrease in pain during activity in both groups. There were no remaining significant differences in the pain levels during activity between the groups. The tendon structure had improved significantly in both groups. There was a significant decrease in the antero-posterior thickness of the proximal patellar tendon in patients treated with US and CD-guided arthroscopic shaving, but not in the sclerosing injection group. The CD flow had diminished significantly in both groups, and there was a correlation between low CD flow and high patient satisfaction in both groups, The CD flow decreased faster in the surgical group than in the injection group. In conclusion, this newly invented US and CD-guided arthroscopic shaving treatment, focusing on treatment outside the tendon, has shown good clinical results with pain relief and a fast return to sports activity, in patients with patellar tendinopathy.
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| 6. |
- Willberg, Lotta, et al.
(författare)
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Sclerosing injections to treat midportion Achilles tendinosis : a randomised controlled study evaluating two different concentrations of Polidocanol.
- 2008
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer. - 0942-2056 .- 1433-7347. ; 16:9, s. 859-864
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Tidskriftsartikel (refereegranskat)abstract
- Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.
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| 7. |
- Willberg, Lotta, et al.
(författare)
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Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper's knee? : a randomised controlled study
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 45:5, s. 411-415
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Proximal patellar tendinopathy/jumper's knee (PT/JK) is well known to be difficult to treat. Recent studies using an ultrasound and colour Doppler-based treatment approach on the dorsal side of the tendon, sclerosing polidocanol injections and ultrasound-guided arthroscopic shaving, have shown promising clinical results. OBJECTIVES: To compare the clinical effects after treatment with sclerosing polidocanol injections and arthroscopic shaving. MATERIAL AND METHODS: 52 patellar tendons (43 men and two women) with ultrasound and colour Doppler-verified diagnosis of PT/JK were randomly assigned to treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections (group A) or ultrasound and colour Doppler-guided arthroscopic shaving (group B). All patients were involved in patellar tendon loading sports or recreational activities, and had had a long duration of pain symptoms from the proximal patellar tendon. Pain during patellar tendon loading activity, and at rest, before and after treatment (visual analogue scale; VAS), and patient satisfaction with the result of the treatment, was registered. RESULTS: After treatment, the patients treated with arthroscopic shaving had a significantly lower VAS score at rest and during activity, and were significantly more satisfied compared with the patients in the sclerosing injection group. CONCLUSIONS: Both treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections and arthroscopic shaving showed good clinical results, but patients treated with arthroscopic shaving had less pain and were more satisfied with the treatment result. Because surgical treatment is a one-stage treatment return to sports was faster in this group.
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