Powerdopplersonografische Befunde der Achillessehnen von 953 Langstreckenläufern – eine Querschnittsstudie

Zusammenfassung

Ziel: Das Ziel dieser Querschnittsuntersuchung war, die Häufigkeit Tendinopathie-typischer Ultraschallbefunde der Achillessehnen in einem großen Kollektiv wettkampforientierter Langstreckenläufer zu erfassen und mit klinisch-anamnestischen und anthropometrischen Probandendaten zu korrelieren. Material und Methode: 1906 Achillessehnen von 953 Läufern wurden in Längs- und Querschnitt powerdopplersonografisch untersucht (Toshiba Aplio SSA-770A/ 80, 12 MHz). Die Sehnendicke sowie die Häufigkeit pathologischer Ultraschallbefunde (Hypo-/Hyperechogenitäten, spindelförmige Verdickung, Neovaskularisationen) wurden dokumentiert und in Abhängigkeit der anthropometrischen Daten und der Anamnese bezüglich akuter und chronischer Achillessehnenbeschwerden analysiert. Ergebnisse: Sowohl bei beschwerdefreien Läufern als auch in der Gesamtgruppe zeigte sich ein statistisch signifikanter Zusammenhang zwischen Sehnendicke und Alter, Körpergröße und Körpergewicht (CC 0,24 – 0,38, p < 0,001). Probanden mit bestehenden oder abgeheilten Achillessehnenbeschwerden wiesen statistisch signifikant dickere Sehnen und häufiger pathologische B-Bild-Befunde bzw. Gefäßneubildungen auf (p < 0,001). Während Hypoechogenitäten und Sehnenverdickungen bei asymptomatischen Läufern selten zu finden waren (< 10 %), konnten mit dem hochauflösenden Powerdoppler „Advanced Dynamic Flow” bei 35 % dieser gesunden Probanden intratendinöse Gefäße detektiert werden. Schlussfolgerung: Entgegen häufig geäußerter Annahmen finden sich mit modernen Sonografiegeräten auch in Sehnen asymptomatischer Laufsportler häufig Mikrogefäße, deren pathologische Relevanz daher kritisch diskutiert werden muss.

Abstract

Aim: The aim of this cross-sectional study was to assess the frequency of tendinopathy-typical Doppler sonographic changes in the Achilles tendons of long distance runners and to correlate these findings with anamnestic and anthropometric data of the subjects. Materials and Methods: 1906 Achilles tendons of 953 long distance runners were examined by ultrasound and power Doppler (Toshiba Aplio SSA-770A/ 80 12 MHz). Ultrasound images (spindle-shaped thickening, hypoechoic/hyperechoic lesions, neovascularizations) were analyzed in relation to the runners’ anthropometrical data and history of Achilles tendon complaints. Results: In asymptomatic runners as well as in the overall group, there was a statistically significant correlation between tendon thickness and age, height and weight (CC 0.24 – 0.38, p < 0.001). Runners with current or healed Achilles tendon complaints displayed a statistically significant thickening of the tendons, as well as an increase in hypoechoic lesions and neovascularizations (p < 0.001). While grayscale abnormalities were rarely found in asymptomatic runners (< 10 %), neovascularization was detected in 35 % of healthy test persons using the high-resolution power Doppler ”Advanced Dynamic Flow”. Conclusion: Contrary to frequent assumption, neovascularization is often found in tendons of asymptomatic runners, using modern power Doppler equipment. The pathological relevance of single microvessels in asymptomatic tendons must, therefore, be critically discussed.

tendons - ultrasound power Doppler - epidemiology - muscular - extremities

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