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1,2 Anti-inflammatory agents, previously used for chronic tendinopathies without appropriate efficacy, 1,6 have now been replaced by eccentric exercises as usual care 6 that provide some positive effects on tendon collagen synthesis and may result in a decrease of pain. 1,7 The recent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.

BackgroundHeterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.AimThe ‘Doha agreement meeting on terminology and definitions in groin pain in athletes’ was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions.MethodsA one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting.ResultsUnanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes:1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain.2. Hip-related groin pain.3. Other causes of groin pain in athletes.The definitions are included in this paper.ConclusionsThe Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.

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.

Objective To assess whether a platelet-rich plasma (PRP) injection leads to an enhanced tendon structure and neovascularisation, measured with ultrasonographic techniques, in chronic midportion Achilles tendinopathy. Design Double-blind, randomised, placebo-controlled clinical trial. Setting Sports medical department of The Hague medical centre. Patients 54 patients with chronic midportion Achilles tendinopathy were included. Interventions Patients were randomised to eccentric exercise therapy with either a PRP injection (PRP group) or a saline injection (placebo group). Main outcome measurements Tendon structure was evaluated by ultrasonographic tissue characterisation, a novel technique which quantifi es tendon structure into four echo-types: echo-types I+II represent organised tendon bundles, whereas echo-types III+IV represent a disorganised tendon structure. Colour Doppler ultrasonography was used to measure the degree of neovascularisation. Follow-up was at 6, 12 and 24 weeks. Results A signifi cant improvement in echo-types I+II was found after 24 weeks within both the PRP group (n=27) and the placebo group (n=27), but there was no signifi cant between-group difference (95% CI −1.6 to 7.8, p=0.169). After 6 weeks, the neovascularisation score increased within the PRP group (p=0.001) and the placebo group (p=0.002), but there was no signifi cant between-group difference in change in neovascularisation score at any point in time. Conclusion Injecting PRP for the treatment of chronic midportion Achilles tendinopathy does not contribute to an increased tendon structure or alter the degree of neovascularisation, compared with placebo.