VERUSE INJURY OF THE ACHILlestendonisafrequentproblem that often affects sport participantsbutalsoinactive middle-aged individuals. 1,2 An estimated 30% to 50% of all sports-related injuries are tendon disorders. 3 Former distance runners have a lifetime risk of 52% for Achilles tendon injury. 4 Achilles tendon injuries frequently lead to sport cessation for long periods and may interfere with activities of daily living. 5 Conservative treatmentisdisappointingand25%to45% of patients eventually require surgery. 1,5 There is a clear need for improved conservative therapy. Many factors in the etiology and pathogenesis have been reported, but no study has identified a direct causeeffect relationship. 1,2 Previously, the nomenclature tendinitis was generally used for chronic tendon disorders, suggesting the presence of inflammation. 1,2 Histological studies, however, proved abnormal tissue repair and degeneration, which favored the term tendinopathy for the clinical triad of pain, swelling, and decreased activity. 1,2 Anti-inflammatory agents, previously used for chronic tendinopathies without appropriate efficacy, 1,6 have now been replaced by eccentric exercises as usual care 6 that provide some positive effects on tendon collagen synthesis and may result in a decrease of pain. 1,7 The recent introduction of plateletrich plasma (PRP) injections in tendinopathy raised high expectations. 8-11 See also Patient Page.

The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study size weighted success rates were calculated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. One randomized clinical trial was identified. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Retrograde drilling and fixation scored 88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus.

UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such, UTC might be useful to monitor treatment protocols.

This is the first report on incidence rates of mid-portion Achilles tendinopathy in general practice. With an incidence of 1.85 per 1,000 registered persons, Achilles tendinopathy is frequently seen by GPs. The actual incidence might even be higher due to study limitations. More research on the frequency of this injury is required.

The aim of this study was to investigate the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to July 1998 were systematically screened. Based on our inclusion criteria 32 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT's) were identified. Fourteen studies described the results of excision alone, 11 the results of (EC), 14 the results of (ECD), 1 the results of cancellous bone grafting after EC, 1 the results of osteochondral transplantation and 3 the results of fixation. The average success rate of non-operative treatment (NT) was 45%. Comparison of different surgical procedures shows that the average highest success rate was reached by excision, curettage and drilling (ECD) (85%) followed by excision and curettage (EC) (78%) and excision alone (38%). Based on this systematic review we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further prospective randomized controlled trials are required to compare the outcome of these two surgical strategies for OCD of the talus.