@article{HirschmuellerFreyDeibertetal.2010,
  author    = {Hirschmueller, Anja and Frey, Virginie and Deibert, Peter and Konstantinidis, Lukas and Mayer, Frank and Suedkamp, Norbert and Helwig, Peter},
  title     = {Powerdopplersonografische Befunde der Achillessehnen von 953 Langstreckenlaeufern : eine Querschnittsstudie},
  issn      = {0172-4614},
  doi       = {10.1055/s-0029-1245189},
  year      = {2010},
  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.},
  language  = {de}
}
@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}
}