Effectiveness of Ultrasound-Guided Interventions on Neovascularization in Achilles Tendinopathy: a Scoping Review

Abstract

Abstract Neovascularization is frequently observed in Achilles tendinopathy. It remains unclear whether neovascularization has a positive or negative impact on the prognosis of Achilles tendinopathy, and whether treatment should include the eradication or positive influence of neovessels. The purpose of this scoping review was to investigate the effect of ultrasound-guided interventions in the treatment of neovascularization in Achilles tendinopathy. Five different ultrasound-guided interventions were identified, which are characterized by an opposite effect. Whereas platelet-rich plasma (PRP) is used to positively influence neovascularization, sclerosing agents, high-volume image-guided injections, electrocoagulation, and hyaluronic acid are used to eradicate neovascularization. Therapies eradicating neovessels, through sclerosis or high-volume image-guided injections, have a long-term effect on the reduction of neovascularization. Moreover, eradication seems to improve pain and function in the short and long term compared to therapy that positively influences neovascularization, such as PRP. PRP induces neovascularization in the short term, but this effect fades out after this period. This review focusses on the role of neovascularization in Achilles tendinopathy and provides evidence supporting the theory that neovascularization is a pathological process rather than a positive impact on healing and remodeling of the tendon. Therapy that positively influences neovascularization in the form of PRP show contradictory results in the treatment of Achilles tendinopathy, while interventions eradicating neovessels demonstrate positive effects in the short and long term.