gms | German Medical Science

124. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

01. - 04.05.2007, München

Eccentric training and a pneumatic Achilles wrap reduce increased Achilles tendon capillary blood flow, reduce capillary venous filling pressures and increase tendon oxygen saturation in insertional und mid-portion tendinopathy – a randomized trial

Meeting Abstract

  • corresponding author K. Knobloch - Plastische, Hand und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
  • L. Schreibmueller - Plastische, Hand und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
  • M. Spies - Plastische, Hand und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
  • P. M. Vogt - Plastische, Hand und Wiederherstellungschirurgie, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Chirurgie. 124. Kongress der Deutschen Gesellschaft für Chirurgie. München, 01.-04.05.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07dgch6947

The electronic version of this article is the complete one and can be found online at:

Published: October 1, 2007

© 2007 Knobloch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Eccentric training has been demonstrated to decrease pain in Achilles tendinopathy in small evidence-based studies. Whether an Achilles wrap in addition to eccentric training changes parameters of tendon microcirculation in insertional and mid-portion tendinopathy is not known. Therefore we performed a randomized-controlled trial.

Materials and methods: 112 subjects with chronic Achilles tendinopathy (>3months) were recruited. A laser Doppler spectrophotometry system (Oxygen-to-see, LEA Medizintechnik, Germany) assessed capillary blood flow, tissue oxygen saturation and postcapillary venous filling pressure. Randomization was performed in group A, who performed daily eccentric training (3x15/d) over 12 weeks with additional daily Achilles wrap (AirHeel™, AIRCAST, 54 tendons of 54 patients), while group B performed the same eccentric training only (3x15/d, 64 tendons of 59 patients).

Results: 91 patients fulfilled the 12-week-daily-training period (81%). Tendon oxygen saturation increased significantly in group A at insertion (70±11 vs. 75±7%, p=0.001) and distal mid-portion (68±12 vs. 73±9%, p=0.006), which was significantly increased vs. group B distal mid-portion (69±11 vs. 68±15%, p=0.041 vs. A). Postcapillary venous filling pressures were significantly reduced in group A at 5/8 positions at two and eight mm tendon depths (up to 26%, p=0.003), while only in 3/8 positions in group B (up to 20%, p=0.001). Pain on VAS was 5.1±2.1 vs. 3.2±2.7 (A, -37.3%, p=0.0001) vs. 5.5±2.1 vs. 3.6±2.4 (B, p=0.0001, -34.6%, p=0.486 for A vs. B). FAOS score was superiorly increased regarding all five items in the combined vs. the eccentric training alone group (range 9-32%, p=0.006).

Discussion: Tendon oxygen saturation is increased and capillary venous clearance facilitated using an Achilles wrap additionally to a daily 12-week eccentric training. Achilles wrap and eccentric training increase subjective assessment superior to eccentric training alone. Neither eccentric training nor the combination with an Achilles wrap adversely affected tendon microcirculation.