Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?

@article{Alfredson2003IsVI,
  title={Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?},
  author={H{\aa}kan Alfredson and Lars {\"O}hberg and Sture Forsgren},
  journal={Knee Surgery, Sports Traumatology, Arthroscopy},
  year={2003},
  volume={11},
  pages={334-338}
}
The purpose of this study was to investigate where the pain comes from in chronic mid-portion Achilles tendinosis, by using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. [...] Key Method Twenty-five tendons in 24 patients (mean age 47 years) with the clinical diagnosis of painful chronic mid-portion Achilles tendinosis, and 20 tendons in 14 controls (mean age 48 years) with pain-free Achilles tendons were examined with ultrasonography and colour Doppler.Expand
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TLDR
Achilles tendinosis is associated with the presence of granulation tissue, haemosiderophages, and SP positive nerve fibres, which may transmit the clinically pertinent pain. Expand
Neovascularisation in chronic tendon injuries detected with colour Doppler ultrasound in horse and man: implications for research and treatment
TLDR
The neovessels found in the horse tendons looked similar to what has recently been presented in human Achilles tendons, motivating evaluation of the same treatment, a sclerosing injection demonstrated recently to give promising results in the treatment of chronic Achilles tendon injuries (tendinosis) in humans. Expand
Are the Symptoms of Calcific Tendinitis Due to Neoinnervation and/or Neovascularization?
TLDR
This is the first study to show a significant increase in neovascularization and neoinnervation in calcific tendinitis lesions of the shoulder along with an eightfold increase in mast cells and macrophages. Expand
The chronic painful Achilles and patellar tendon: research on basic biology and treatment
  • H. Alfredson
  • Medicine
  • Scandinavian journal of medicine & science in sports
  • 2005
TLDR
It is demonstrated that it is possible to use intratendinous microdialysis to investigate human tendons, and normal prostaglandin E2 levels are found in chronic painful tendinosis (Achilles and patellar) tenders, and gene technological analyses of biopsies showed no upregulation of pro‐inflammatory cytokines. Expand
The Pain of Tendinopathy: Physiological or Pathophysiological?
TLDR
New hypotheses for this condition are proposed, which focus on the potential role of tenocytes, mechanosensitive and chemosensitive receptors, the role of ion channels in nociception and pain and central mechanisms associated with load and threat monitoring. Expand
Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?
TLDR
In patients with chronic painful mid-portion Achilles tendinosis, a good clinical result after eccentric training seems to be associated with a more normal tendon structure and no remaining neovascularisation. Expand
Treatment of midportion Achilles tendinosis: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing polidocanol injections
TLDR
Both treatment with sclerosing polidocanol injections and open surgical revision outside the ventral Achilles midportion show promising short-term clinical results. Expand
Chronic tendon pain: no tendinitis, but high levels of glutamate and a vasculoneural ingrowth – implications for a new treatment?
TLDR
The findings indicate that glutamate might be involved in chronic tendon pain and that there is no intratendinous prostaglandin E2-mediated inflammation during the chronic stage of these so-called tendinopathies. Expand
Neoinnervation in Rotator Cuff Tendinopathy
TLDR
Data support the hypothesis that early tendinopathy is associated with increases of newly grown nerve fibers and blood vessels inside and around tendinopathic tendon, and these may be the source of pain in Tendinopathy. Expand
Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy.
TLDR
Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT and sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Expand
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References

SHOWING 1-10 OF 24 REFERENCES
Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation
TLDR
In all tendons with a painful nodule, but not in any of the normal pain-free tendons, neovascularisation was seen in the area with tendon changes (localised widening of the tendon with focal hypo-echoic areas). Expand
High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique
TLDR
In this investigation the microdialysis technique was used to study the concentrations of lactate in Achilles tendons with painful chronic tendinosis and in normal pain‐free tendons, where the painful thickening corresponded to a widened tendon and structural tendinotic changes. Expand
Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin
TLDR
Traditional dogma would have it that pain in tendinopathy arises through one of two mechanisms, but a number of studies provide data inconsistent with either theory. Expand
Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment
TLDR
Sclerosing neovessels appears to be an effective treatment for painful chronic Achilles tendinosis, suggesting that neovessel play a key part in causing chronic tendon pain. Expand
On the nature and etiology of chronic achilles tendinopathy
TLDR
Most patients were athletes but physical activity was not correlated to histopathology and could be more important in provoking symptoms than in the evolution of the actual lesion, refuted the popular theory of the mid-tendon hypovascular zone as a cause of ruptures and chronic lesions. Expand
Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients.
TLDR
Changes in the fiber structure and arrangement, as well as increased amounts of interfibrillar GAG, appear to be characteristic morphological features in Achilles tendons with long-standing achillodynia and ultrasonographic widening, which may indicate that achillingnia is due to local disturbances in connective tissue metabolism or circulation or to both. Expand
Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases
TLDR
Comparisons of ultrasonography and MRI in chronic achilles tendinopathy with regard to the nature and severity of the lesion suggest these methods give similar information and may have their greatest potential as prognostic instruments. Expand
Histopathology of Common Tendinopathies
TLDR
The histopathological findings in athletes with overuse tendinopathies are consistent with those in tendinosis — a degenerative condition of unknown aetiology, which may have implications for the prognosis and timing of a return to sport after experiencing tendon symptoms. Expand
In vivo investigation of ECRB tendons with microdialysis technique--no signs of inflammation but high amounts of glutamate in tennis elbow
TLDR
In situ microdialysis can be used to study certain metabolic events in the ECRB tendon of the elbow to indicate involvement of the excitatory neurotransmitter glutamate, but no biochemical signs of inflammation (normal PGE 2 levels) in E CRB tendons from patients with tennis elbow. Expand
In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain
TLDR
In situ microdialysis appears a useful method to study certain metabolic events in tendon tissue and the higher concentrations of the excitatory neurotransmitter glutamate in Achilles tendons with a painful nodule may possibly be involved in the pain mechanism in this chronic condition. Expand
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