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

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2025-01-28 DOI:10.1136/military-2023-002521
M A Paantjens, P H Helmhout, F J G Backx, M T A W Martens, E W P Bakker
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Abstract

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 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.

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 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.

Trial registration number: https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm, file number ToetsingOnline NL69527.028.19.

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超声组织特征对军人跟腱中段病变复发的预后价值:一项前瞻性队列研究。
引言:跟腱中段病变(mid-AT)的肌腱结构与症状的相关性较差。然而,影像学上的退行性肌腱改变与中期at的风险增加有关。我们的目的是研究超声组织表征(UTC)对在标准治疗后报告恢复的服役人员中期at复发的预后价值。方法:对37例受试者进行治疗后正中排列的纤维结构量化。随访1年后,根据自我感觉复发(是/否)以及治疗后victoria Institute of Sports Assessment-Achilles评分至少减少7分的最小重要变化来确定复发情况。使用受试者工作特征曲线分析来确定对齐纤维结构结果二分类的阈值(正常代表/不足代表)。使用多变量逻辑回归,确定中期at复发(是/否)与二分排列的纤维结构之间的关系。结果:8例(22%)复发。根据约登指数,纤维排列结构的阈值为73.2% (95% CI: 69.4%至77.8%)。低于该阈值与中期at复发显著相关(优势比(OR) 9.7, 95% CI: 1.007 ~ 93.185)。症状持续时间每增加一个月,中期at复发的OR为1.1 (95% CI: 1.002 ~ 1.150)。多元logistic回归模型的解释方差为0.423;症状持续时间似乎是比排列的纤维结构更好的预测因子。结论:本研究确定了中部排列的纤维结构和症状持续时间是军人中期at复发的潜在预后因素。纤维结构对齐的阈值为73.2%,可以指导预防性干预措施(例如,训练负荷调整或额外的肌腱负荷计划),旨在改善肌腱结构,以尽量减少未来复发的风险。试验注册号:https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm,文件号:ToetsingOnline NL69527.028.19。
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来源期刊
Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
3.10
自引率
20.00%
发文量
116
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