@article{CasselBaurHirschmuelleretal.2015,
  author    = {Cassel, Michael and Baur, Heiner and Hirschmueller, Anja and Carlsohn, Anja and Fr{\"o}hlich, Katja and Mayer, Frank},
  title     = {Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes},
  series = {Scandinavian journal of medicine \& science in sports},
  volume    = {25},
  journal   = {Scandinavian journal of medicine \& science in sports},
  number    = {3},
  publisher = {Wiley-Blackwell},
  address   = {Hoboken},
  issn      = {0905-7188},
  doi       = {10.1111/sms.12318},
  pages     = {e310 -- e318},
  year      = {2015},
  abstract  = {Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 +/- 1.9 years; 160 +/- 13cm; 50 +/- 14kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8\% and patellar tendinopathy in 5.8\%. Vascularizations were visible in 3.0\% of ATs and 11.4\% of PTs, hypoechogenicities in 0.7\% and 3.2\% as well as hyperechogenicities in 0\% and 0.3\%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.},
  language  = {en}
}
@article{HirschmuellerFreyKonstantinidisetal.2012,
  author    = {Hirschmueller, Anja and Frey, Victoria and Konstantinidis, Lukas and Baur, Heiner and Dickhuth, Hans-Hermann and Suedkamp, Norbert P. and Helwig, Peter},
  title     = {Prognostic value of achilles tendon doppler sonography in asymptomatic runners},
  series = {Medicine and science in sports and exercise : official journal of the American College of Sports Medicine},
  volume    = {44},
  journal   = {Medicine and science in sports and exercise : official journal of the American College of Sports Medicine},
  number    = {2},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0195-9131},
  doi       = {10.1249/MSS.0b013e31822b7318},
  pages     = {199 -- 205},
  year      = {2012},
  abstract  = {HIRSCHMULLER, A., V. FREY, L. KONSTANTINIDIS, H. BAUR, H-H. DICKHUTH, N. P. SUDKAMP, and P. HELWIG. Prognostic Value of Achilles Tendon Doppler Sonography in Asymptomatic Runners. Med. Sci. Sports Exerc., Vol. 44, No. 2, pp. 199-205, 2012. Introduction: Midportion Achilles tendinopathy (MPT) is a common problem in running athletes. Nevertheless, its etiology is not fully understood, and no valid prognostic criterion to predict the development of MPT could be identified to date. The purpose of the present study, therefore, was to evaluate whether power Doppler ultrasonography (PDU) is a suitable method to identify a predisposition to MPT in yet asymptomatic runners. Methods: At 23 major running events, 634 asymptomatic long-distance runners were tested for Achilles tendon thickness, vascularization, and structural abnormalities using a high-resolution PDU device (Toshiba Aplio SSA-770A/80, 12 MHz). In addition, their medical history and anthropometric data were documented. All subjects were contacted 6 and 12 months later and asked about any new symptoms. The collected anamnestic, anthropometric, and ultrasonographic data were subjected to regression analysis to determine their predictive value concerning the manifestation of midportion Achilles tendon complaints (P < 0.05). Results: The highest odds ratio (OR) for manifestation of MPT within 1 yr was found for intratendinous blood flow ("neovascularization,'' OR = 6.9, P < 0.001). An increased risk was also identified for subjects with a positive history of Achilles tendon complaints (OR = 3.8, P < 0.001). A third relevant parameter, just above the level of significance, was a spindle-shaped thickening of the tendon on PDU (Wald chi(2) = 3.42). Conclusions: PDU detection of intratendinous microvessels in the Achilles tendons of healthy runners seems to be a prognostically relevant factor concerning the manifestation of symptomatic MPT. This finding lays the foundation for an early identification of a predisposition to MPT as well as prophylactic intervention in as yet asymptomatic runners.},
  language  = {en}
}