@article{RischWochatzMesserschmidtetal.2017,
  author    = {Risch, Lucie and Wochatz, Monique and Messerschmidt, Janin and Engel, Tilman and Mayer, Frank and Cassel, Michael},
  title     = {Reliability of evaluating achilles tendon vascularization assessed with doppler ultrasound advanced dynamic flow},
  series = {Journal of ultrasound in medicine},
  volume    = {37},
  journal   = {Journal of ultrasound in medicine},
  number    = {3},
  publisher = {Wiley},
  address   = {Hoboken},
  issn      = {0278-4297},
  doi       = {10.1002/jum.14414},
  pages     = {737 -- 744},
  year      = {2017},
  abstract  = {The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. Methods-Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen kappa and Fleiss kappa coefficients (absolute), Kendall tau b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]). Results-Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels). Conclusions-The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.},
  language  = {en}
}
@misc{RischMayerCassel2021,
  author    = {Risch, Lucie and Mayer, Frank and Cassel, Michael},
  title     = {Doppler flow response following running exercise differs between healthy and tendinopathic Achilles tendons},
  series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-52136},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-521367},
  pages     = {12},
  year      = {2021},
  abstract  = {Background: The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear. Objective: This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants. Methods: 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound "Advanced dynamic flow" examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (\%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05). Results: At baseline, IBF was detected in 40\% (3 [1-6]) of Hrun, in 53\% (4 [1-5]) of Hrec, in 85\% (3 [1-25]) of Trun, and 70\% (10 [2-30]) of Trec. At U5 IBF responded to exercise in 30\% (3 [-1-9]) of Hrun, in 53\% (4 [-2-6]) of Hrec, in 70\% (4 [-10-10]) of Trun, and in 80\% (5 [1-10]) of Trec. While IBF in 80\% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60\% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05). Conclusion: Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.},
  language  = {en}
}
@article{CasselRischIntziegiannietal.2018,
  author    = {Cassel, Michael and Risch, Lucie and Intziegianni, Konstantina and Mueller, Juliane and Stoll, Josefine and Brecht, Pia and Mayer, Frank},
  title     = {Incidence of achilles and patellar tendinopathy in adolescent elite athletes},
  series = {International journal of sports medicine},
  volume    = {39},
  journal   = {International journal of sports medicine},
  number    = {9},
  publisher = {Thieme},
  address   = {Stuttgart},
  issn      = {0172-4622},
  doi       = {10.1055/a-0633-9098},
  pages     = {726 -- 732},
  year      = {2018},
  abstract  = {The study investigated the incidence of Achilles and patellar tendinopathy in adolescent elite athletes and non-athletic controls. Furthermore, predictive and associated factors for tendinopathy development were analyzed. The prospective study consisted of two measurement days (M1/M2) with an interval of 3.2 +/- 0.9 years. 157 athletes (12.1 +/- 0.7 years) and 25 controls (13.3 +/- 0.6 years) without Achilles/patellar tendinopathy were included at Ml. Clinical and ultrasound examinations of both Achilles (AT) and patellar tendons (PT) were performed. Main outcome measures were incidence tendinopathy and structural intratendinous alterations (hypo-/hyperechogenicity, vascularization) at M2 [\%]. Incidence of Achilles tendinopathy was 1\% in athletes and 0\% in controls. Patellar tendinopathy was more frequent in athletes (13 \%)than in controls (4\%). Incidence of intratendinous alterations in ATs was 1-2\% in athletes and 0 \% in controls, whereas in PTs it was 4-6 \% in both groups (p >0.05). Intratendinous alterations at M2 were associated with patellar tendinopathy in athletes (p <= 0.01). Intratendinous alterations at M1, anthropometric data, training amount, sports or sex did not predict tendinopathy development (p>0.05). Incidence often dinopathy and intratendinous alterations in adolescent athletes is low in ATs and more common in PTs. Development of intratendinous alterations in PT is associated with tend in opathy. However, predictive factors could not be identified.},
  language  = {en}
}
@article{RischMayerCassel2021,
  author    = {Risch, Lucie and Mayer, Frank and Cassel, Michael},
  title     = {Doppler flow response following running exercise differs between healthy and tendinopathic Achilles tendons},
  series = {Frontiers in Physiology},
  volume    = {12},
  journal   = {Frontiers in Physiology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-042X},
  doi       = {10.3389/fphys.2021.650507},
  pages     = {10},
  year      = {2021},
  abstract  = {Background: The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear. Objective: This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants. Methods: 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound "Advanced dynamic flow" examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (\%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05). Results: At baseline, IBF was detected in 40\% (3 [1-6]) of Hrun, in 53\% (4 [1-5]) of Hrec, in 85\% (3 [1-25]) of Trun, and 70\% (10 [2-30]) of Trec. At U5 IBF responded to exercise in 30\% (3 [-1-9]) of Hrun, in 53\% (4 [-2-6]) of Hrec, in 70\% (4 [-10-10]) of Trun, and in 80\% (5 [1-10]) of Trec. While IBF in 80\% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60\% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05). Conclusion: Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.},
  language  = {en}
}