Ultrasound evaluation of tendinopathy in haemophilic patient for the purpose of rehabilitation indication

Research Objectives: The aim of the study is to evaluate the state of the satellite tendons of the target joints in the patient with haemophilic arthropathy and propose a rehabilitation treatment with eccentric exercises.

Design: interventional pilot study

Setting: The study is conducted in Physical and Rehabilitation Unit of the Rizzoli Orthopedic Institute

Participants: The criteria for enrollment of patients with hemophilic arthropathy are:
Inclusion criteria:
1. Age between 18 and 65 years
2. Radiological / ultrasound signs of haemophilic arthropathy

Exclusion criteria:
1. Patients undergoing elbow, knee and ankle arthroplasty
2. Patients undergoing ankle arthrodesis
3. Patients undergoing knee and ankle synovectomy

Interventions: The ultrasound examination is performed with a linear probe with pre-set musculoskeletal preset for muscle-tendon evaluation.
The ultrasound evaluation is associated with the use of evaluation scales such as the Hemophilia Joint Health Score (HJHS) for the measurement of joint damage, the Functional Independence Score in Haemophilia (FISH), the Haemophilia Activity List (HAL), the DASH for impairment and disability, the VISA-A scale for achilles tendinopathy, the VISA-P scale for patellar tendinopathy and the VAS scale for pain.

Main Outcome Measures: The ultrasound parameters evaluated are:
1)maximum tendon thickness
2) echogenicity and echostructure alteration
3) signs of hyperemia on power-color doppler
4) calcifications / other tendon ultrasound findings

Results: 20 patients with haemophilic arthropaty are eligible according to the criteria of the study. In the 20 patients examined the thickness of the tendons is normal. In 6 subjects with severe joint damage, echostructural alterations are present, and signs of hyperemia and neo-vascularisation are detected on color-doppler and the presence of intratendinous calcifications.

Conclusions: The tendons of the target joints in the patient with haemophilic arthropathy are likely not directly compromised by the underlying disease but by the indirect biomechanical damage caused by the haemophilic joint disease and the rehabilitation treatment with eccentric exercises is safe and effective in improving the tenso-elastic properties of the tendons.

Author(s) Disclosures: the author declare no conflict of interest