Midportion Achilles Tendon Microcirculation after Intermittent Combined Cryotherapy and Compression Compared with Cryotherapy Alone: A Randomized Trial

Background The effect of combined cryotherapy/compression versus cryotherapy alone on the Achilles tendon is undetermined. Hypothesis Standardized combined cryotherapy/compression changes in midportion Achilles tendon microcirculation are superior to those with cryotherapy during intermittent application. Study Design Controlled laboratory study. Methods Sixty volunteers were randomized for either combined cryotherapy/compression (Cryo/Cuff, DJO Inc, Vista, California: n = 30; 32 ± 11 years) or cryotherapy alone (KoldBlue, TLP Industries, Kent, United Kingdom: n = 30; 33 ± 12 years) with intermittent 3 × 10-minute application. Midportion Achilles tendon microcirculation was determined (02C, LEA Medizintechnik, Giessen, Germany). Results Both Cryo/Cuff and KoldBlue significantly reduced superficial and deep capillary tendon blood flow within the first minute of application (43 ± 46 arbitrary units [AU] vs 10 ± 19 AU and 42 ± 46 AU vs 12 ± 10 AU; P = .0001) without a significant difference throughout all 3 applications. However, during recovery, superficial and deep capillary blood flow was reestablished significantly faster using Cryo/Cuff (P = .023). Tendon oxygen saturation was reduced in both groups significantly (3 minutes Cryo/Cuff: 36% ± 20% vs 16% ± 15%; KoldBlue: 42% ± 19% vs 28% ± 20%; P < .05) with significantly stronger effects using Cryo/Cuff (P = .014). Cryo/Cuff led to significantly higher tendon oxygenation (Cryo/Cuff: 62% ± 28% vs baseline 36% ± 20%; P = .0001) in superficial and deep tissue (Cryo/Cuff: 73% ± 14% vs baseline 65% ± 17%; P = .0001) compared with KoldBlue during all recoveries. Postcapillary venous filling pressures were significantly reduced in both groups during application; however, Cryo/Cuff led to significantly, but marginally, lower pressures (Cryo/Cuff: 41 ± 7 AU vs baseline 51 ± 13 AU; P = .0001 and KoldBlue: 46 ± 7 AU vs baseline 56 ± 11 AU; P = .026 for Cryo/Cuff vs KoldBlue). Conclusion Increased tendon oxygenation is achieved as tendon preconditioning by combined cryotherapy and compression with significantly increased tendon oxygen saturation during recovery in contrast to cryotherapy alone. Both regimens lead to a significant amelioration of tendinous venous outflow. Clinical Relevance Combined cryotherapy and compression is superior to cryotherapy alone regarding the Achilles tendon microcirculation. Further studies in tendinopathy and tendon rehabilitation are warranted to elucidate its value regarding functiona