Conservative treatment of chronic Achilles tendinopathy

Scott, Alexander; Huisman, Elise; Khan, Karim M.

doi:10.1503/cmaj.101680

Cited by 49 publications

(43 citation statements)

References 37 publications

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“…This may reflect a gender related predisposition but may also reflect sampling bias, and the higher proportion of males partaking in elite sport. Sixty eight per cent of patients with an ITT played an elite level of sport in comparison to only 14% with a mid-tendon tendinopathy (statistically significant) with the two most represented sports being football and sprinting athletics, again agreeing with the Achilles tendinopathy literature 31 . This is useful for clinicians, as a typical risk profile can be formulated.…”

Section: Patient Characteristicssupporting

confidence: 60%

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Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort

Chan

Morton

Pritchard

et al. 2017

MLTJ

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SummaryBackground: Achillodynia is common and includes Achilles tendinopathy, partial Achilles tears and Achilles tendon ruptures. However, we believe an additional pathology should be considered for Achillodynia differentials -the intratendinous tear (ITT). Methods: Examinations of 740 achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively. Results: 5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36.3 years (range 20-64), significantly lower than mid-tendon tendinopathy (8.48 years; p<0.01). 92% had concurrent Achilles tendinopathy. Elite sportspeople were more highly represented in the ITT than mid-tendon tendi nopathy groups (86.2% ITT group vs 13.8% mid-tendon AT group; p<0.01). Conclusions: ITTs should be actively searched for in patients with Achilles pathology, especially in elite male athletes with a history of high-impact pain. Prospective research is warranted concerning diagnosis and management. Level of evidence: IV.

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Section: Patient Characteristicssupporting

confidence: 60%

“…Seventy eight percent of subjects with an ITT was male, corresponding to the previous work showing Achilles tendinopathy to be more common in male subjects 31 . This may reflect a gender related predisposition but may also reflect sampling bias, and the higher proportion of males partaking in elite sport.…”

Section: Patient Characteristicssupporting

confidence: 54%

Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort

Chan

Morton

Pritchard

et al. 2017

MLTJ

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“…The diagnosis of tendinopathy is based on pain (which in severe cases may interfere with activities of daily living), swelling and impaired performance; morning stiffness is common and patients may have decreased strength and endurance of the calf muscles 6,10,15. In the past, the term ‘Achilles tendonitis’ was used as the aetiology was assumed to be inflammatory (and treatment included corticosteroids and non-steroidal anti-inflammatory drugs) 16,17.…”

Section: About Achilles Tendinopathymentioning

confidence: 99%

“…Early intervention is preferable as management becomes more complicated and less predictable once the condition becomes chronic 5. Other treatments that have been tried, particularly once the condition becomes chronic, include eccentric exercises, ESWT, topical nitroglycerin, low level laser therapy, orthoses, splints, injections or surgery 4–6,8…”

Section: About Achilles Tendinopathymentioning

confidence: 99%

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Management of chronic Achilles tendinopathy

2012

DTB

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Tendons transmit force between muscles and bones and, when stretched, store elastic energy that contributes to movement.(1) The tendinous portion of the gastrocnemius and soleus muscles merge to form the Achilles tendon, which is the largest and strongest in the body, but one of the most frequently injured.(2,3) Conservative management options for chronic Achilles tendinopathy include eccentric (lengthening) exercises, extracorporeal shockwave therapy (ESWT), topical nitroglycerin, low level laser therapy, orthoses, splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma), while a minority of patients require surgery (using open, percutaneous or endoscopic methods).(4-8) Here we assess the management options for patients with chronic Achilles tendinopathy (lasting over 6 weeks).

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Pathogenesis and management of tendinopathies in sports medicine

et al. 2018

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Tendinopathy is a major clinical problem in sports medicine and is often difficult to treat. Traditional therapeutic approaches have focused on reducing inflammation, yet research suggests that little to no inflammation is present in the tendons that fail to heal. The purpose of this review was to evaluate the effectiveness of the available treatment options for tendinopathy and to inform best clinical practices. A comprehensive search of electronic databases (PubMed, Google Scholar, and Web of Science) was conducted to identify relevant studies through June 2016. Studies were deemed relevant if they were published in English and contained original research on the management of tendinopathy in humans. Studies varied in methodological quality and were often limited by small sample size and lack of sufficient control groups. Critical evaluation of the literature suggests that physical therapy with or without eccentric exercise should be considered a first-line treatment. Corticosteroids and non-steroidal anti-inflammatory drugs provide short-term symptomatic relief, but long-term efficacy has not been demonstrated. Inconsistent results do not support the routine use of prolotherapy, platelet-rich plasma injections, and topical nitric oxide patches. Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present. While numerous therapeutic modalities exist for tendinopathy in the athlete, the ideal treatment protocol has not been clearly defined. The development of new targeted therapies for tendinopathy is likely to follow a greater understanding of the cellular and molecular mechanisms that underlie its pathogenesis.

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Conservative treatment of chronic Achilles tendinopathy

Cited by 49 publications

References 37 publications

Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort

Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort

Management of chronic Achilles tendinopathy

Pathogenesis and management of tendinopathies in sports medicine

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