Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy

Abstract

Objective: To assess the relationship between muscle-tendon function and symptoms in patients with Achilles tendinopathy using a validated test battery.

Design: A prospective non-randomised trial.

Setting: Orthopaedic Department, Sahlgrenska University Hospital, Sweden.

Patients: 37 patients with a clinical diagnosis of Achilles tendinopathy in the midportion of the tendon, with symptoms for >2 months, were evaluated at the initiation of the study and after 1 year.

Intervention: The patients were treated using a rehabilitation programme, under the supervision of a physical therapist, for 6 months.

Main outcome measurements: The patients were evaluated using the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) for symptoms, and a test battery for evaluation of the lower leg muscle-tendon function.

Results: There were significant improvements in the VISA-A-S score (p<0.00, n = 37) and the test battery (p<0.02, n = 19) at the 1-year follow-up. The VISA-A-S questionnaire had an effect size of 2.1 and the test battery had an effect size of 0.73. A low correlation (r = 0.178, p>0.05) was found between the VISA-A-S score and the test battery. A high correlation (r = 0.611, p<0.05) was found between the drop counter movement jump and the VISA-A-S score. All other tests in the test battery had low correlations (r = -0.305 to 0.155, p>0.05) with the VISA-A-S score. Only 25% (4/16) of the patients who had full symptomatic recovery had achieved full recovery of muscle-tendon function as measured by the test battery.

Conclusion: Full symptomatic recovery in patients with Achilles tendinopathy does not ensure full recovery of muscle-tendon function. The VISA-A-S questionnaire and the test battery are sensitive to clinically relevant changes with treatment and can be recommended for use in both the clinic and research.