Advancement of medical imaging modalities, such as ultrasound, has significantly helped researchers and health professionals visualise dimensional and morphologic changes within the tendon, such as may occur with overuse injuries amongst athletes. Both Magnetic Resonance Imaging (MRI) and ultrasound have unique benefits and limitations. MRI may be better suited where there is a need for a differential diagnosis while ultrasound can be used to demonstrate active and passive movements in real time. Ultrasound is more portable and has greater accessibility and affordability over MRI however, ultrasound is more operator dependent [5]. There is little research that have made a direct comparison between ultrasound and MRI, however a study investigating
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Laser Doppler imaging is non-invasive and accepted as a gold standard of choice for blood flow analysis, however it is expensive and not widely available, therefore applying it in a clinical setting is impractical [7]. Colour Doppler (CD) is another technique to assess tendon vascularity which is widely available on regular ultrasound equipment. However, CD does not commonly detect intratendinous vascularity in an at rest normal tendon as the vessels are too small when compared with pathological or post-exercise tendon vessels (where the vessel has increased in size), and therefore lacks face and content validity in the detection of the complete spectrum of blood flow in the normal tendon [8]. Vascularity, dimensional and morphologic changes in the patellar and Achilles tendons have been associated with pathology, exercise and pain [19,20,43] suggesting that ultrasound and CD is a valid test to demonstrate changes due to these constructs. There is moderate evidence that Doppler can predict future injury [9]. Two systematic reviews will be undertaken in this research to investigate in more detail the existing evidence of reliability and validity of CD in the Achilles and patellar tendons as part of this research project (see table of contents). Literature review
The following literature review will outline the current understanding of physiology and …show more content…
Dynamic tissue makes up the tendon which are composed of cells capable of responding to mechanical cues that alter the extracellular matrix. They exhibit high tensile strength that allow for the efficient transmission of large loads. The local cell population adapts to changes in loading conditions with normal, physiologic loads required to maintain tendon homeostasis and prevent excessive degradation of the extracellular matrix [14]. Load on the tendon during exercise lead to changes in the characteristics of the cell and the nature of cell proliferation. Following loading of the tendon the tendon cells appear more chondroid-shaped rather than spindle-shaped, which allows for an increase in protein production. The primary proteins involved are large proteoglycans, which result in an increase in the amount of water in the tendon
Laser Doppler imaging is non-invasive and accepted as a gold standard of choice for blood flow analysis, however it is expensive and not widely available, therefore applying it in a clinical setting is impractical [7]. Colour Doppler (CD) is another technique to assess tendon vascularity which is widely available on regular ultrasound equipment. However, CD does not commonly detect intratendinous vascularity in an at rest normal tendon as the vessels are too small when compared with pathological or post-exercise tendon vessels (where the vessel has increased in size), and therefore lacks face and content validity in the detection of the complete spectrum of blood flow in the normal tendon [8]. Vascularity, dimensional and morphologic changes in the patellar and Achilles tendons have been associated with pathology, exercise and pain [19,20,43] suggesting that ultrasound and CD is a valid test to demonstrate changes due to these constructs. There is moderate evidence that Doppler can predict future injury [9]. Two systematic reviews will be undertaken in this research to investigate in more detail the existing evidence of reliability and validity of CD in the Achilles and patellar tendons as part of this research project (see table of contents). Literature review
The following literature review will outline the current understanding of physiology and …show more content…
Dynamic tissue makes up the tendon which are composed of cells capable of responding to mechanical cues that alter the extracellular matrix. They exhibit high tensile strength that allow for the efficient transmission of large loads. The local cell population adapts to changes in loading conditions with normal, physiologic loads required to maintain tendon homeostasis and prevent excessive degradation of the extracellular matrix [14]. Load on the tendon during exercise lead to changes in the characteristics of the cell and the nature of cell proliferation. Following loading of the tendon the tendon cells appear more chondroid-shaped rather than spindle-shaped, which allows for an increase in protein production. The primary proteins involved are large proteoglycans, which result in an increase in the amount of water in the tendon