Achilles Tendinopathy: Aetiology and Management

Maffulli, Nicola; Sharma, Pankaj; Luscombe, Karen L

doi:10.1177/0141076809701004

Cited by 260 publications

(200 citation statements)

References 47 publications

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“…Several treating options are available for these conditions [4,29]. Physiotherapy and steroid injections have proved to have no long-term efficacy [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Patellar tendinopathy (a degeneration of the tendon enthesis caused by a repetitive and/or chronic overloading that exceeds the adaptive capacity of the tendon) and Achilles tendinopathy (a degenerative tendinous disorder that commonly involves the hypovascular area located from 2 to 6 cm above the calcaneal insertion) are commonly considered the result of multiple micro-tears that do not heal because of poor tendon vascularity [2,3]. Histological features in the early stages of the disease are focal areas of asymptomatic intratendineous damage without signs of inflammation [4,5]. Histological appearance of degenerative damage begins and progresses long before onset of symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ferrero

Fabbro

Orlandi

et al. 2012

Journal of Ultrasound

117

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KEYWORDSPlatelet-rich plasma; Achilles tendon; Patellar tendon; Jumper's knee; Achilles tendinopathy.Abstract Purpose: The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy. Materials and methods: Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 AE 16 years, range 20e61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests. Results: 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57 e75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler. Conclusion: PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy. Sommario Scopo: Il plasma ricco di piastrine (PRP), provocando un iperafflusso di citochine nel sito di iniezione si è dimostrato efficace, sia in vitro che in studi clinici in vivo, come promotore della rigenerazione tissutale. Lo scopo di questo studio è quello di valutare l'efficacia dell'iniezione ecoguidata di PRP autologo nel trattamento delle tendinopatie croniche del rotuleo e dell'achilleo. Materiali e metodi: Il PRP autologo è stato iniettato sotto guida ecografica in tendini rotulei e achillei (30 tendini di Achille, 28 tendini rotulei) di 48 pazienti selezionati in modo prospettico (30 maschi, 18 femmine, età media 38 AE 16 anni, range 20e61 anni). Tutti i pazienti erano stati precedentemente valutati mediante questionario Victoria Institute of Sport di valutazione (VISA) in cui si analizza il punteggio del dolore e il livello di attività. È stata poi eseguita una valutazione ecografica dei tendini mirata a valutarne l'ecostruttura e vascolarizzazione. La valutazione statistica dei dati ottenuti è stata eseguita mediante i test del Chi-quadrato e di Wilcoxon. Risultati: Venti giorni dopo l'iniezione di PRP è stato rilevato un miglioramento dei sintomi clinici non significativo. Il punteggio VISA è migliorato da una base di 57 a 75,5 a 6 mesi (p < .01). La v...

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“…Several treating options are available for these conditions [4,29]. Physiotherapy and steroid injections have proved to have no long-term efficacy [30,31].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ferrero

Fabbro

Orlandi

et al. 2012

Journal of Ultrasound

117

View full text Add to dashboard Cite

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“…Excessive long-distance running, intensity, and hill work are risk factors for acute Achilles tendinopathy [60,70,95]; distance and excessive time spent swimming are associated with supraspinatus tendinopathy [98]. There is also an association between tendinopathy and hormone replacement therapy and oral contraceptives in women [47].…”

Section: Common Intrinsic and Extrinsic Associationsmentioning

confidence: 99%

The Basic Science of Tendinopathy

Murrell

2008

Clinical Orthopaedics &Amp; Related Research

314

254

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Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the ''dose'' of load to the tendon enthesis -including increased activity, weight, advancing age, and genetic factors. The cells in tendinopathic tendon are rounder, more numerous, and show evidence of oxidative damage and more apoptosis. These cells also produce a matrix that is thicker and weaker with more water, more immature and cartilage-like matrix proteins, and less organization. There is now evidence of a population of regenerating stem cells within tendon. These studies suggest prevention of tendinopathy should be directed at reducing the volume of repetitive loads to below that which induces oxidative-induced apoptosis and cartilage-like genes. The management strategies might involve agents or cells that induce tendon stem cell proliferation, repair and restoration of matrix integrity.

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“…Excessive load during vigorous training may further stimulate degeneration, and lack of flexibility and underlying genetic and metabolic variables may play a role [29] [27]. This degeneration may be entirely asymptomatic but symptomatic tendinopathy is thought to occur when these regions become subject to microtrauma or fail.…”

Section: Biomechanics/ Mechanism Of Injurymentioning

confidence: 99%

“…This degeneration may be entirely asymptomatic but symptomatic tendinopathy is thought to occur when these regions become subject to microtrauma or fail. These changes typically occur in the middle third of the tendon (known as the critical zone), particularly medially, and this portion of the tendon is the most poorly vascular [29]. Recent studies using ultrasound of the Achilles have shown that intratendinous hypoechoic areas in asymptomatic ballet dancers [30] or areas of abnormal neovascularity or tendon thickening in asymptomatic runners [31] may be predictive of future symptoms with continued sporting activity.…”

Section: Biomechanics/ Mechanism Of Injurymentioning

confidence: 99%

Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics

et al. 2013

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This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Elias, D. A., Carne, A., Bethapudi, S., Engebretsen, L., Budgett, R., O'Connor, P. (2013 AbstractPlantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games.

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Achilles Tendinopathy: Aetiology and Management

Cited by 260 publications

References 47 publications

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

The Basic Science of Tendinopathy

Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics

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