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Journal articles on the topic 'Achilles tendinopathy (AT)'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Roche, A. J., and J. D. F. Calder. "Achilles tendinopathy." Bone & Joint Journal 95-B, no. 10 (October 2013): 1299–307. http://dx.doi.org/10.1302/0301-620x.95b10.31881.

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The two main categories of tendo Achillis tendon disorder are broadly classified by anatomical location to include non-insertional and insertional conditions. Non-insertional Achilles tendinopathy is often managed conservatively, and many rehabilitation protocols have been adapted and modified, with excellent clinical results. Emerging and popular alternative therapies, including a variety of injections and extracorporeal shockwave therapy, are often combined with rehabilitation protocols. Surgical approaches have developed, with minimally invasive procedures proving popular. The management of insertional Achilles tendinopathy is improved by recognising coexisting pathologies around the insertion. Conservative rehabilitation protocols as used in non-insertional disorders are thought to prove less successful, but such methods are being modified, with improving results. Treatment such as shockwave therapy is also proving successful. Surgical approaches specific to the diagnosis are constantly evolving, and good results have been achieved.

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2

Arya, Shruti, and Kornelia Kulig. "Tendinopathy alters mechanical and material properties of the Achilles tendon." Journal of Applied Physiology 108, no. 3 (March 2010): 670–75. http://dx.doi.org/10.1152/japplphysiol.00259.2009.

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The purpose of this study was to investigate the in vivo material and mechanical properties of the human Achilles tendon in the presence of tendinopathy. Real-time ultrasound imaging and dynamometry were used to assess Achilles tendon stiffness, Young's modulus, stress, strain, and cross-sectional area (CSA) in 12 individuals with Achilles tendinopathy and 12 age- and gender-matched controls. The results of this study suggest that tendinopathy weakens the mechanical and material properties of the tendon. Tendinopathic tendons had greater CSA, lower tendon stiffness, and lower Young's modulus. These alterations in mechanical characteristics may put the Achilles tendon at a higher risk to sustain further injury and prolong the time to recovery. Results from this study may be used to design treatment strategies that specifically target these deficits, leading to faster and permanent recovery from tendinopathy.

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3

Oh, Seo Yoon, Do Kyung Kim, Soo Hong Han, Hyun Hae Lee, Yunhui Jeong, Minjung Baek, Hyeongkyung Kim, Wooyeol Ahn, and Soonchul Lee. "Sustained Exposure of Substance P Causes Tendinopathy." International Journal of Molecular Sciences 21, no. 22 (November 16, 2020): 8633. http://dx.doi.org/10.3390/ijms21228633.

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Recently, neuromediators such as substance P (SP) have been found to be important factors in tendon homeostasis. Some studies have found SP to be the cause of inflammation and tendinopathy, whereas others have determined it to be a critical component of tendon healing. As demonstrated by these conflicting findings, the effects of SP on tendinopathy remain unclear. In this study, we hypothesized that the duration of SP exposure determines its effect on the tendons, with repetitive long-term exposure leading to the development of tendinopathy. First, we verified the changes in gene and protein expression using in vitro tenocytes with 10-day exposure to SP. SP and SP + Run groups were injected with SP in their Achilles tendon every other day for 14 days. Achilles tendons were then harvested for biomechanical testing and histological processing. Notably, tendinopathic changes with decreased tensile strength, as observed in the Positive Control, were observed in the Achilles in the SP group compared to the Negative Control. Subsequent histological analysis, including Alcian blue staining, also revealed alterations in the Achilles tendon, which were generally consistent with the findings of tendinopathy in SP and SP + Run groups. Immunohistochemical analysis revealed increased expression of SP in the SP group, similar to the Positive Control. In general, the SP + Run group showed worse tendinopathic changes. These results suggest that sustained exposure to SP may be involved in the development of tendinopathy. Future research on inhibiting SP is warranted to target SP in the treatment of tendinopathy and may be beneficial to patients with tendinopathy.

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Yasui, Youichi, Ichiro Tonogai, Andrew J. Rosenbaum, Yoshiharu Shimozono, Hirotaka Kawano, and John G. Kennedy. "The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States." BioMed Research International 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/7021862.

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Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy.Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed.Results.Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients). Older patients with tendinopathy were most vulnerable to subsequent rupture.Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy.

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Dakin, Stephanie Georgina, Julia Newton, Fernando O. Martinez, Robert Hedley, Stephen Gwilym, Natasha Jones, Hamish A. B. Reid, et al. "Chronic inflammation is a feature of Achilles tendinopathy and rupture." British Journal of Sports Medicine 52, no. 6 (November 8, 2017): 359–67. http://dx.doi.org/10.1136/bjsports-2017-098161.

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BackgroundRecent investigation of human tissue and cells from positional tendons such as the rotator cuff has clarified the importance of inflammation in the development and progression of tendon disease. These mechanisms remain poorly understood in disease of energy-storing tendons such as the Achilles. Using tissue biopsies from patients, we investigated if inflammation is a feature of Achilles tendinopathy and rupture.MethodsWe studied Achilles tendon biopsies from symptomatic patients with either mid-portion tendinopathy or rupture for evidence of abnormal inflammatory signatures. Tendon-derived stromal cells from healthy hamstring and diseased Achilles were cultured to determine the effects of cytokine treatment on expression of inflammatory markers.ResultsTendinopathic and ruptured Achilles highly expressed CD14+ and CD68+ cells and showed a complex inflammation signature, involving NF-κB, interferon and STAT-6 activation pathways. Interferon markers IRF1 and IRF5 were highly expressed in tendinopathic samples. Achilles ruptures showed increased PTGS2 and interleukin-8 expression. Tendinopathic and ruptured Achilles tissues expressed stromal fibroblast activation markers podoplanin and CD106. Tendon cells isolated from diseased Achilles showed increased expression of pro-inflammatory and stromal fibroblast activation markers after cytokine stimulation compared with healthy hamstring tendon cells.ConclusionsTissue and cells derived from tendinopathic and ruptured Achilles tendons show evidence of chronic (non-resolving) inflammation. The energy-storing Achilles shares common cellular and molecular inflammatory mechanisms with functionally distinct rotator cuff positional tendons. Differences seen in the profile of ruptured Achilles are likely to be attributable to a superimposed phase of acute inflammation and neo-vascularisation. Strategies that target chronic inflammation are of potential therapeutic benefit for patients with Achilles tendon disease.

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6

Koike, Yoichi, Hans K. Uhthoff, Nanthan Ramachandran, Geoffrey P. Doherty, Martin Lecompte, David S. Backman, and Guy Trudel. "Achilles Tendinopathy." Critical Reviews in Physical and Rehabilitation Medicine 16, no. 2 (2004): 109–32. http://dx.doi.org/10.1615/critrevphysrehabilmed.v16.i2.30.

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7

Tabane, Ck. "Achilles tendinopathy." South African General Practitioner 3, no. 1 (March 2022): 22–25. http://dx.doi.org/10.36303/sagp.2022.3.1.0109.

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8

Kaplan, Kelby, Ovidio Olivencia, Melissa Dreger, William J. Hanney, and Morey J. Kolber. "Achilles Tendinopathy." Strength and Conditioning Journal 41, no. 5 (October 2019): 24–40. http://dx.doi.org/10.1519/ssc.0000000000000485.

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9

PAAVOLA, MIKA, PEKKA KANNUS, TERO A. H. JÄRVINEN, KARIM KHAN, LÁSZLO JÓZSA, and MARKKU JÄRVINEN. "ACHILLES TENDINOPATHY." Journal of Bone and Joint Surgery-American Volume 84, no. 11 (November 2002): 2062–76. http://dx.doi.org/10.2106/00004623-200211000-00024.

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10

Cook, J. L., K. M. Khan, and C. Purdam. "Achilles tendinopathy." Manual Therapy 7, no. 3 (August 2002): 121–30. http://dx.doi.org/10.1054/math.2002.0458.

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11

Luscombe, K., P. Sharma, and N. Maffulli. "Achilles tendinopathy." Trauma 5, no. 4 (October 1, 2003): 215–25. http://dx.doi.org/10.1191/1460408603ta285oa.

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12

Ferns, Gordon. "Achilles Tendinopathy." Journal of the Royal Society of Medicine 97, no. 12 (December 2004): 608. http://dx.doi.org/10.1177/014107680409701222.

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13

Clarke, G. R. "Achilles Tendinopathy." Journal of the Royal Society of Medicine 98, no. 3 (March 2005): 137. http://dx.doi.org/10.1177/014107680509800326.

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14

Maffulli, Nicola, Umile Giuseppe Longo, Anish Kadakia, and Filippo Spiezia. "Achilles tendinopathy." Foot and Ankle Surgery 26, no. 3 (April 2020): 240–49. http://dx.doi.org/10.1016/j.fas.2019.03.009.

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15

Ferns, G. "Achilles tendinopathy." JRSM 97, no. 12 (December 1, 2004): 608. http://dx.doi.org/10.1258/jrsm.97.12.608-a.

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16

Clarke, G. R. "Achilles tendinopathy." Journal of the Royal Society of Medicine 98, no. 3 (March 1, 2005): 137. http://dx.doi.org/10.1258/jrsm.98.3.137-b.

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17

Longo, Umile Giuseppe, Mario Ronga, and Nicola Maffulli. "Achilles Tendinopathy." Sports Medicine and Arthroscopy Review 26, no. 1 (March 2018): 16–30. http://dx.doi.org/10.1097/jsa.0000000000000185.

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18

Longo, Umile Giuseppe, Mario Ronga, and Nicola Maffulli. "Achilles Tendinopathy." Sports Medicine and Arthroscopy Review 17, no. 2 (June 2009): 112–26. http://dx.doi.org/10.1097/jsa.0b013e3181a3d625.

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19

Chang, Huan J. "Achilles Tendinopathy." JAMA 303, no. 2 (January 13, 2010): 188. http://dx.doi.org/10.1001/jama.303.2.188.

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20

Bernstein, David N., Michael R. Anderson, Judith F. Baumhauer, Irvin Oh, A. Samuel Flemister, John P. Ketz, and Benedict F. DiGiovanni. "A Comparative Analysis of Clinical Outcomes in Noninsertional Versus Insertional Tendinopathy Using PROMIS." Foot & Ankle Specialist 12, no. 4 (October 19, 2018): 350–56. http://dx.doi.org/10.1177/1938640018806662.

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Background. Achilles tendinopathy is a common clinical disorder. Utilizing the Patient-Reported Outcomes Measurement Information System, we aim to determine clinical response to nonoperative achilles tendinopathy rehabilitative care of insertional achilles tendinopathy compared to non-insertional achilles tendinopathy. Methods. Prospective Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Depression scores were collected for patients with achilles tendinopathy at presentation and following a standard course of nonoperative care. A distribution-based method was used to determine the minimal clinically important difference. Descriptive statistics were reported and bivariate analysis was used to compare insertional achilles tendinopathy and non-insertional achilles tendinopathy. Receiver operating characteristic curve analysis was used to predict clinical improvement. Results. A total of 102 patients with an average follow-up of 68 days were included. For the non-insertional achilles tendinopathy group: Fifteen (46%), 12 (36%) and 9 (27%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. For the insertional achilles tendinopathy group: Seventeen (25%), 20 (29%) and 22 (32%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. Physical Function scores improved more in non-insertional achilles tendinopathy patients (4.0 vs. -0.046; p = 0.035) and more patients clinically improved (45.5% vs. 24.6%; p = 0.034). Patients with non-insertional and insertional achilles tendinopathy clinically improved functionally when initial Physical Function scores were equal to or lower than 40.25 and 38.08, respectively. Conclusions. Nonoperative care in achilles tendinopathy is often successful. The Patient-Reported Outcomes Measurement Information System can be used to evaluate and help determine clinical success. Levels of Evidence: Level II: Prospective comparative study

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21

Matthews, Wesley, Richard Ellis, James Furness, and Wayne A. Hing. "The clinical diagnosis of Achilles tendinopathy: a scoping review." PeerJ 9 (September 28, 2021): e12166. http://dx.doi.org/10.7717/peerj.12166.

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Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

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22

Callow, Joanne H., Mark Cresswell, Faraz Damji, Joshua Seto, Antony J. Hodgson, and Alex Scott. "The Distal Free Achilles Tendon Is Longer in People with Tendinopathy than in Controls: A Retrospective Case-Control Study." Translational Sports Medicine 2022 (August 28, 2022): 1–9. http://dx.doi.org/10.1155/2022/6585980.

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Objectives. The free Achilles tendon is defined as the region of tendon distal to the soleus which is “unbuttressed,” i.e., unsupported by muscular tissue. We reasoned that a relative lack of distal buttressing could place the tendon at a greater risk for developing Achilles tendinopathy. Therefore, our primary goal was to compare the free Achilles tendon length between those with midportion or insertional Achilles tendinopathy and healthy controls. Design. This is a retrospective case-control study. Setting. Hospital in Vancouver, Canada. Participants. 66 cases with Achilles tendinopathy (25 insertional, 41 midportion) consecutively drawn from a hospital database within a 5-year period and matched to 66 controls (without tendinopathy) based on sex, age, and weight. Main outcome measures. Odds ratio of the risk of developing Achilles tendinopathy given the length of free tendon, defined anatomically on MRI, after adjustment for confounders. Results. MRI-defined free Achilles tendon length is a statistically significant predictor of having midportion Achilles tendinopathy (odds ratio = 0.53, 95% confidence interval 1.13 to 2.07). Midportion Achilles tendinopathy cases had significantly longer free tendons (Mdn = 51.2 mm, IQR = 26.9 mm) compared to controls (Mdn = 40.8 mm, IQR = 20.0 mm), p = 0.007 . However, there was no significant difference between the free Achilles tendon lengths in insertional AT cases (Mdn = 47.9 mm, IQR = 15.1 mm) and controls (Mdn = 39.2 mm, IQR = 17.9 mm), p = 0.158 . Free Achilles tendon length was also correlated with the tendon thickness among those with Achilles tendinopathy, rτ = 0.25, and p = 0 .003 . Conclusions. The MRI-defined length of the free Achilles tendon is positively associated with the risk of midportion Achilles tendinopathy. A relative lack of distal muscular buttressing of the Achilles tendon may therefore influence the development of tendinopathy.

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Rafique, Iqra, Anam Manzoor, and Sana Naseer. "Diagnostic Accuracy of Ultrasonography for Detection of AT by Taking Surgical Findings as Gold Standard." Pakistan Journal of Medical and Health Sciences 15, no. 11 (November 30, 2021): 3093–95. http://dx.doi.org/10.53350/pjmhs2115113093.

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Objective: To assess the diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard. Design of the Study: It was a descriptive cross-sectional study. Study Settings: This study was carried out at Department Of Diagnostic Radiology And Diagnostic Imaging Combined Military Hospital, Lahore from 23rd December 2017 to 22nd June 2018. Material and Methods: A total of 70 patients of age 20-70 years, of either gender presenting with severe pain and swelling in area of Achilles tendon were included. Patients with heel pain having concurrent heel ulcer, eczematous changes or calcaneal fractures, muscular dystrophy and previous surgery were excluded. All the patients were then underwent ultrasonography and findings were noted for presence or absence of Achilles tendinopathy. Each Ultrasonographic finding were compared with surgical findings. Results of the Study: Mean age was 41.24 ± 10.34 years. Out of these 70 patients, 46 (65.71%) were male and 24 (34.29%) were females with male to female ratio of 1.9:1. In USG positive patients, 40 (True Positive) had Achilles tendinopathy and 04 (False Positive) had no Achilles tendinopathy on surgical findings. Among, 26 USG negative patients, 03 (False Negative) had Achilles tendinopathy on surgical findings whereas 23 (True Negative) had no Achilles tendinopathy on surgical findings. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard was 93.02%, 85.19%, 90.91%, 88.46% and 90.0% respectively. Conclusion: This study concluded that diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy is quite high. Keywords: Achilles tendinopathy, ultrasonography, sensitivity.

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Honório, Lucas Candido, Mariana Alcantara Roldi de Azeredo, and Joaquim Maluf Neto. "Insertional Achilles tendinopathy." Journal of the Foot & Ankle 14, no. 1 (April 30, 2020): 68–73. http://dx.doi.org/10.30795/jfootankle.2020.v14.1163.

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Objective: Retrospectively analyze surgical procedures performed on patients with insertional Achilles (calcaneal tendon) tendinopathy, focusing on outcomes and the impact on the patients’ functional quality. Methods: A descriptive, retrospective, case series study drawn up by collecting data directly from the patients’ medical records. For the functional analysis of patients, we used the questionnaire of the adapted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). An assessment was carried out on each of the patients who underwent surgery at our hospital from 2010 to 2019, using the surgical technique described in this article, i.e., resection of the affected portion of the tendon with its subsequent reinsertion. Results: All surgical patients achieved an improvement in their AOFAS score and in pain levels, with good functional performance only three months into the postoperative period, from 50.1 to 83.75 (p<0.001). Conclusion: The use of the technique proved very effective, particularly in terms of the maintenance of foot function and important improvement in pain levels, thus producing a relevant increase in function among patients. Level of Evidence IV; Therapeutic Study; Case Series.

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25

McShane, John M., Brian Ostick, and Frank McCabe. "Noninsertional Achilles Tendinopathy." Current Sports Medicine Reports 6, no. 5 (October 2007): 288–92. http://dx.doi.org/10.1097/01.csmr.0000306490.15530.b6.

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26

Kearney, R. S., N. Parsons, and M. L. Costa. "Achilles tendinopathy management." Bone & Joint Research 2, no. 10 (October 2013): 227–32. http://dx.doi.org/10.1302/2046-3758.210.2000200.

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27

Åström, Mats, and Alf Rausing. "Chronic Achilles Tendinopathy." Clinical Orthopaedics and Related Research &NA;, no. 316 (July 1995): 151–64. http://dx.doi.org/10.1097/00003086-199507000-00021.

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28

Caudell, Gage M. "Insertional Achilles Tendinopathy." Clinics in Podiatric Medicine and Surgery 34, no. 2 (April 2017): 195–205. http://dx.doi.org/10.1016/j.cpm.2016.10.007.

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29

Krishna Sayana, Murali, and Nicola Maffulli. "Insertional Achilles Tendinopathy." Foot and Ankle Clinics 10, no. 2 (June 2005): 309–20. http://dx.doi.org/10.1016/j.fcl.2005.01.010.

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30

Hennessy, Michael S., Andrew P. Molloy, and Simon W. Sturdee. "Noninsertional Achilles Tendinopathy." Foot and Ankle Clinics 12, no. 4 (December 2007): 617–41. http://dx.doi.org/10.1016/j.fcl.2007.07.006.

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31

Petersen, Wolf, Robert Welp, and Dieter Rosenbaum. "Chronic Achilles Tendinopathy." American Journal of Sports Medicine 35, no. 10 (October 2007): 1659–67. http://dx.doi.org/10.1177/0363546507303558.

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Background Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. Hypothesis AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). Results The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. Conclusions The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. Clinical Relevance The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

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Irsan, Istan Irmansyah, and R. Muhammad David Jayanegara. "The Effect of CaCl2 Added PRP (Platelet Rich Plasma) to the Healing Time, Tensile Strength and Adhesion Degree of the Ruptured Tendinopathic Achilles Tendon of Rats (Rattus norvegicus)." Berkala Kedokteran 15, no. 1 (March 14, 2019): 59. http://dx.doi.org/10.20527/jbk.v15i1.6123.

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Abstract: Achilles tendinopathy produce morbidity, long-lasting disability in athletes and non-athletes and remain a challenge for clinician. Tendinopathy may lead to reduced tensile strength and a predisposition to rupture.The aim of our study was to evaluate the effects of activated and non-activated PRP on the healing process of ruptured tendinopathic achilles tendon in rat. Tendinopathy achilles condition induced by injecting collagenase bacterial type-1 locally. Right achilles tendon in 48 rats ruptured by transecting it transversely and repaired it by using a Kessler technique. Further, the wound immobilized with PRP and injecting activated PRP (5% CaCl2 added) in one group, non-activated PRP on the other group and saline on control group. Tendons from each group were collected at the 1st and 2nd week postoperatively also assessed for biomechanical test. Tendons were also evaluated histologically by using hematoxylin-eosin to know adhesion degree based on Tang criteria. The significant differences was found between intervention group and control (p<0.05) at the 1st week but there was not any significant differences at the 2nd week in tensile strength test (p>0.05). Adhesion degree of the intervention group also reduce better rather than the control at the 1st and 2nd week (p<0.05). PRP have a positive effect on healing tendons by improving healing time, mechanical strength and decreasing adhesion degree. Keywords: achilles tendinopathy, PRP, healing time, tensile strength, adhesion

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33

Merry, Kohle, Christopher Napier, Charlie M. Waugh, and Alex Scott. "Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications." Journal of Clinical Medicine 11, no. 16 (August 12, 2022): 4722. http://dx.doi.org/10.3390/jcm11164722.

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Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual’s ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.

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Wezenbeek, Evi, Tine Willems, Nele Mahieu, Martine De Muynck, Luc Vanden Bossche, Adelheid Steyaert, Dirk De Clercq, and Erik Witvrouw. "The Role of the Vascular and Structural Response to Activity in the Development of Achilles Tendinopathy: A Prospective Study." American Journal of Sports Medicine 46, no. 4 (January 26, 2018): 947–54. http://dx.doi.org/10.1177/0363546517750854.

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Background: Several risk factors have been suggested in the development of Achilles tendinopathy, but large-scale prospective studies are limited. Purpose: To investigate the role of the vascular response to activity of the Achilles tendon, tendon thickness, ultrasound tissue characterization (UTC) of tendon structure, and foot posture as possible risk factors in the development of Achilles tendinopathy. Study Design: Cohort study; Level of evidence, 2. Methods: The study began with 351 first-year students at Ghent University. After 51 students were excluded, 300 were tested in the academic years 2013-2014 and 2014-2015 and were followed prospectively for 2 consecutive years by use of a multilevel registration method. Of those, 250 students were included in the statistical analysis. At baseline, foot posture index and UTC were investigated bilaterally. Blood flow and tendon thickness were measured before and after a running activity. Cox regression analyses were performed to identify significant contributors to the development of Achilles tendinopathy. Results: During the 2-year follow-up, 27 of the included 250 participants developed Achilles tendinopathy (11%). Significant predictive effects were found for female sex and blood flow response after running ( P = .022 and P = .019, respectively). The risk of developing Achilles tendinopathy increased if the blood flow increase after running was reduced, regardless of sex, foot pronation, and timing of flow measurements. The model had a predictive accuracy of 81.5% regarding the development of Achilles tendinopathy, with a specificity of 85.0% and a sensitivity of 50.0%. Conclusion: This prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy. UTC of tendon structure, Achilles tendon thickness, and foot posture did not significantly contribute to the prediction of Achilles tendinopathy. A general evaluation of tendon structure by UTC, measurement of tendon thickness, or determination of the foot posture index will not allow clinicians to identify patients at risk for developing Achilles tendinopathy. Furthermore, it may be possible to improve blood flow after activity by using noninvasive techniques (such as prostaglandins, compression stockings, heat, massage, and vibration techniques). These techniques may be useful in the prevention and management of Achilles tendinopathy, but further research is needed.

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Kim, Du-Hwan, Jae-Hyeong Choi, Chul-Hyun Park, Hee-Jin Park, Kyung-Jae Yoon, and Yong-Taek Lee. "The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain." Journal of Clinical Medicine 10, no. 10 (May 17, 2021): 2165. http://dx.doi.org/10.3390/jcm10102165.

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No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.

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Martín Llantino, Pedro Javier, Patricia Vázquez Rigueira, David Rodríguez Sanz, Carlos Romero Morales, and César Calvo Lobo. "Tendinopatía aquilea y ejercicio excéntrico, una revisión narrativa." European Journal of Podiatry / Revista Europea de Podología 4, no. 1 (February 9, 2018): 10. http://dx.doi.org/10.17979/ejpod.2018.4.1.3173.

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Objetivos: El objetivo principal de esta revisión bibliográfica es conocer la aplicación más eficaz según la ciencia de ejercicio excéntrico (EE) a la hora de manejar la TA. Los objetivos secundarios son conocer las diferencias entre sexos al recibir el tratamiento de ejercicio excéntrico en la TA y conocer el mecanismo de acción del EE en la TA. Material y Métodos: Se realizó una búsqueda bibliográfica en la base de datos PubMed. Se usaron los siguientes términos: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. Se seleccionaron artículos que aportaban calidad metodológica, relevancia científica, o una visión novedosa.Resultados: Se encontraron artículos que apoyan la aplicación de EE como tratamiento de la TA y la dosificación recomendada. Se encontraron varios artículos que teorizan sobre los efectos del EE en la TA. Se encontró un artículo que diferencia los efectos del EE en hombres y en mujeres en la TA.Conclusiones: El EE sería el tratamiento de elección en una TA. El protocolo de Alfedson cuenta con la mayoría de los apoyos científicos. En el futuro será necesario realizar estudios de mayor calidad metodológica sobre diferentes opciones de ejercicio. No quedan claros cuáles son los mecanismos de acción del EE en la TA. Queda demostrado que los efectos del EE en las mujeres son limitados en comparación con los hombres.

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Li, Hong-Yun, and Ying-Hui Hua. "Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments." BioMed Research International 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/6492597.

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Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.

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Cassel, Michael, Lucie Risch, Konstantina Intziegianni, Juliane Mueller, Josefine Stoll, Pia Brecht, and Frank Mayer. "Incidence of Achilles and Patellar Tendinopathy in Adolescent Elite Athletes." International Journal of Sports Medicine 39, no. 09 (June 25, 2018): 726–32. http://dx.doi.org/10.1055/a-0633-9098.

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AbstractThe study investigated the incidence of Achilles and patellar tendinopathy in adolescent elite athletes and non-athletic controls. Furthermore, predictive and associated factors for tendinopathy development were analyzed. The prospective study consisted of two measurement days (M1/M2) with an interval of 3.2±0.9 years. 157 athletes (12.1±0.7 years) and 25 controls (13.3±0.6 years) without Achilles/patellar tendinopathy were included at M1. Clinical and ultrasound examinations of both Achilles (AT) and patellar tendons (PT) were performed. Main outcome measures were incidence tendinopathy and structural intratendinous alterations (hypo-/hyperechogenicity, vascularization) at M2 [%]. Incidence of Achilles tendinopathy was 1% in athletes and 0% in controls. Patellar tendinopathy was more frequent in athletes (13%) than in controls (4%). Incidence of intratendinous alterations in ATs was 1-2% in athletes and 0% in controls, whereas in PTs it was 4-6% in both groups (p>0.05). Intratendinous alterations at M2 were associated with patellar tendinopathy in athletes (p≤0.01). Intratendinous alterations at M1, anthropometric data, training amount, sports or sex did not predict tendinopathy development (p>0.05). Incidence of tendinopathy and intratendinous alterations in adolescent athletes is low in ATs and more common in PTs. Development of intratendinous alterations in PT is associated with tendinopathy. However, predictive factors could not be identified.

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Zhang, Jianying, Feng Li, Daibang Nie, Kentaro Onishi, MaCalus V. Hogan, and James H.-C. Wang. "Effect of Metformin on Development of Tendinopathy Due to Mechanical Overloading in an Animal Model." Foot & Ankle International 41, no. 12 (November 12, 2020): 1455–65. http://dx.doi.org/10.1177/1071100720966318.

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Background: Tendinopathy is a debilitating tendon disorder that affects millions of Americans and costs billions of health care dollars every year. High mobility group box 1 (HMGB1), a known tissue damage signaling molecule, has been identified as a mediator in the development of tendinopathy due to mechanical overloading of tendons in mice. Metformin (Met), a drug approved by the Food and Drug Administration used for the treatment of type 2 diabetes, specifically inhibits HMGB1. This study tested the hypothesis that Met would prevent mechanical overloading-induced tendinopathy in a mouse model of tendinopathy created by intensive treadmill running (ITR). Methods: C57BL/6J mice (female, 3 months old) were equally separated into 4 groups and treated for 24 weeks as follows: group 1 had cage control activities, group 2 received a single intraperitoneal injection of Met (50 mg/kg body weight) daily, group 3 underwent ITR to induce tendinopathy, and group 4 received daily Met injection along with ITR to inhibit HMGB1. Tendinopathic changes were assessed in Achilles tendons of all mice using histology, immunohistochemistry, and enzyme-linked immunosorbent assays. Results: ITR induced HMGB1 release into the tendon matrix and developed characteristics of tendinopathy as evidenced by the expression of macrophage marker CD68, proinflammatory molecules (COX-2, PGE2), cell morphological changes from normal elongated cells to round cells, high levels of expression of chondrogenic markers (SOX-9, collagen type II), and accumulation of proteoglycans in tendinopathic tendons. Daily injection of Met inhibited HMGB1 release and decreased these degenerative changes in ITR tendons. Conclusions: Inhibition of HMGB1 by injections of Met prevented tendinopathy development due to mechanical overloading in the Achilles tendon in mice. Clinical Relevance: Met may be able to be repurposed as a therapeutic option for preventing the development of tendinopathy in high-risk patients.

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Netto, Cesar de Cesar, Zijun Zhang, Mario Lobao Goncalves, Chris Cychosz, Shuyuan Li, Kyle R. Duchman, Jessica E. Goetz, John E. Femino, Ruth Chimenti, and Lew C. Schon. "Mechanical Overload Followed by Consecutive Collagenase Injections: Developing a Multifactorial and Long-Lasting Animal Model of Induced Achilles Tendinopathy." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0003. http://dx.doi.org/10.1177/2473011420s00034.

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Category: Basic Sciences/Biologics; Hindfoot; Sports Introduction/Purpose: Different animal models of Achilles tendinopathy have been proposed in the literature. They usually involve the induction of tendinopathic findings by either chemical stress (most commonly with one or more injections of collagenase, mimicking intrinsic factors) or mechanical stress (by repetitive exercise-induced stress with treadmill running exercises, simulating extrinsic risk factors). To date, no study has evaluated the combination of a mechanical trigger followed by collagenase injections, replicating the logical and sequential steps involved in the development the human pathology. Our goal was to develop this novel animal model of Achilles tendinopathy and to compare histological and functional findings with animals subjected to isolated mechanical or chemical stress, as well as to controls. Methods: Sixty-four Sprague-Dawley rats were divided into four groups (n=16): isolated treadmill running protocol (15o uphill running, 20meters/minute, 1hour/day, 3 weeks duration, weeks 2-4); isolated injections of collagenase (0.1mg each, 3 injections total, weeks 5-7); treadmill protocol (weeks 2-4) followed by three consecutive collagenase injections (weeks 5-7); and controls, no running and three injections of normal saline (weeks 5-7). Five animals from each group were sacrificed at weeks 8 and 10. Six animals by group were sacrificed at week 12. Gait analysis was performed at weeks one (after acclimation), five (following running protocol), eight (following injection protocol) and twelve (just before latest sacrifice time-point). Histological findings were assessed by the Movin Tendinopathy Score (eight parameters, scored from 0-3, total score 0-24), assessing collagen arrangement, structure, and stainability, cellularity, vascularity, nuclear rounding, hyalinization and presence of glycosaminoglycans. Gait parameters included stand and swing times, stride length, duty cycle and swing length. Results: After 8 weeks, significantly increased tendinopathic scores (p<0.001) were found in animals subjected to collagenase injections (16, CI 13.1-18.9) and to running/collagenase (17.4, CI 14.4-20.3), when compared to controls (1.6, CI -1.3-4.50) and running (3, CI 0.1-5.9). Similarly, after 10 weeks significantly increased scores were found in the same groups, with slight severity regression: controls (1, CI -0.8-2.8), running (2.2, CI 0.4-4.0), collagenase (10, CI 8.2-11.8) and running/collagenase (17.6, CI 15.8- 19.4). After 12 weeks, collagenase group demonstrated reversion of the findings (3.3, CI 1.6-5.1), and wasn’t different than control (2.1, CI 0.4-3.9) and running groups (2.5, CI 0.3-4.7). However, significantly increased pathological findings were noted in the running/collagenase group (20.0, CI 18.2-21.8) consistent with chronic tendinopathic process. Gait analysis results presented in Figure1. Conclusion: When compared to other models of induced Achilles tendinopathy and to controls, the novel animal model induced by a mechanical trigger and sustained by chemical stress demonstrated progressively increased histological tendinopathic scores after 12 weeks. Findings observed after isolated mechanical or chemical stresses were temporary, not maintained at latest follow- up. Steps involved in tendinopathy development, as well as the observed histological results of the combined running/collagenase model, replicate better the findings of human chronic Achilles tendinopathy. Applications for this novel model are promising, potentially supporting a better understanding of early/late findings as well as treatment options for Achilles tendinopathy. [Figure: see text]

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Owoeye, Oluwatoyosi B. A., Luz Palacios-Derflingher, Kati Pasanen, Tate HubkaRao, Preston Wiley, and Carolyn A. Emery. "The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study." International Journal of Environmental Research and Public Health 18, no. 18 (September 8, 2021): 9480. http://dx.doi.org/10.3390/ijerph18189480.

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This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

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Joseph, Michael F., Jeffrey M. Anderson, Thomas H. Trojian, and John Crowley. "Incidence of Morphologic Changes in Asymptomatic Achilles Tendons in an Active Young Adult Population." Journal of Sport Rehabilitation 21, no. 3 (August 2013): 249–53. http://dx.doi.org/10.1123/jsr.21.3.249.

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Context:Achilles tendon rupture is often the result of a long-term degenerative process, frequently occurring asymptomatically.Objective:To determine the prevalence of asymptomatic Achilles tendinopathy in an active, asymptomatic, young-adult population and to compare these findings across gender.Design:Convenience sample, cohort study.Setting:Research laboratoryParticipants:A sample of 52 (28 male, 24 female) healthy, active subjects were recruited from the student body at the University of Connecticut. Images of 104 Achilles tendons were made.Intervention:Ultrasound images made with a Phillips HD11 with a 15-MHz real-time linear-array transducer were collected on both the longitudinal and transverse axes of the Achilles tendon. Activity level was measured with the International Physical Activity Questionnaire Short Form (IPAQ-SF).Main Outcome Measure:Presence of ultrasound evidence of Achilles tendinopathy as agreed on by 2 blinded assessors highly skilled in ultrasonography.Results:More subjects were categorized as highly active (57.4%) on the IPAQ-SF than moderately active (42.6%). One female and one male subject were found to have ultrasound evidence of asymptomatic Achilles tendinopathy, equaling 3.8% prevalence in this study.Conclusion:We found a low prevalence of asymptomatic Achilles tendinopathy in an active, young-adult population. Further work is necessary to identify an optimal group warranting ultrasound screening for asymptomatic tendinopathy.

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Prus, Igor, Kenneth Bielak, and Rebecca Morgan. "Ciprofloxacin Induced Achilles Tendinopathy." Medicine & Science in Sports & Exercise 49, no. 5S (May 2017): 202. http://dx.doi.org/10.1249/01.mss.0000517396.73570.50.

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Lebrun, Constance M. "Management of Achilles Tendinopathy." Clinical Journal of Sport Medicine 18, no. 1 (January 2008): 106–7. http://dx.doi.org/10.1097/01.jsm.0000307722.46126.e7.

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Pearce, Christopher J., and Audrey Tan. "Non-insertional Achilles tendinopathy." EFORT Open Reviews 1, no. 11 (November 2016): 383–90. http://dx.doi.org/10.1302/2058-5241.1.160024.

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Bardin, Lynn. "Comments on ‘Achilles tendinopathy’." Manual Therapy 8, no. 3 (August 2003): 189. http://dx.doi.org/10.1016/s1356-689x(03)00049-3.

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Cook, J. "Management of Achilles tendinopathy." Journal of Science and Medicine in Sport 16 (December 2013): e39. http://dx.doi.org/10.1016/j.jsams.2013.10.092.

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Tumia, Nezar, Diary Kader, Bruno Arena, and Nicola Maffulli. "Achilles Tendinopathy During Pregnancy." Clinical Journal of Sport Medicine 12, no. 1 (January 2002): 43–45. http://dx.doi.org/10.1097/00042752-200201000-00013.

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Maffulli, Nicola, Vittorino Testa, Giovanni Capasso, and Alessio Sullo. "Calcific Insertional Achilles Tendinopathy." American Journal of Sports Medicine 32, no. 1 (January 2004): 174–82. http://dx.doi.org/10.1177/0363546503258923.

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Atik, O. Sahap. "Photobiomodulation for Achilles Tendinopathy." Photomedicine and Laser Surgery 36, no. 1 (January 2018): 1–2. http://dx.doi.org/10.1089/pho.2017.4361.

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