Molecular and Structural Effects of Percutaneous Interventions in Chronic Achilles Tendinopathy

Abstract

Achilles tendinopathy (AT) is a common problem, especially in people of working age, as well as in the elderly. Although the pathogenesis of tendinopathy is better known, therapeutic management of AT remains challenging. Various percutaneous treatments have been applied to tendon lesions: e.g., injectable treatments, platelet-rich plasma (PRP), corticosteroids, stem cells, MMP inhibitors, and anti-angiogenic agents), as well as percutaneous procedures without any injection (percutaneous soft tissue release and dry needling). In this review, we will describe and comment on data about the molecular and structural effects of these treatments obtained in vitro and in vivo and report their efficacy in clinical trials. Local treatments have some impact on neovascularization, inflammation or tissue remodeling in animal models, but evidence from clinical trials remains too weak to establish an accurate management plan, and further studies will be necessary to evaluate their value.

Dual Acting Carbon Monoxide Releasing Molecules and Carbonic Anhydrase Inhibitors Differentially Modulate Inflammation in Human Tenocytes

“…Among them, rotator cuff tears (RCTs) and rotator cuff disease (RCD) are two of the most frequent and disabling, reaching percentages between 30 to 70% in the middle-aged population [ 1 ]. To date, the use of NSAIDs in chronic tendinopathies is open to discussion, despite their use as painkillers in the acute phase being well documented [ 6 ]. Thus, an established and accounted therapeutic strategy for RCTs and RCD is still needed.…”

“…As expected, tenocytes in the DMSO control display an increased G2 phase compared to the one of T0 (16.9% and 8.44%, respectively). It is well known indeed that in response to overuse or inflammation, tenocytes increase their metabolic activity and multiply [ 6 , 27 ]. In the presence of Meloxicam, percentages of cells in the various phases of cell cycle are comparable to the ones of the DMSO control.…”

“…To date, there is no established therapeutic strategy in RCTs and RCD due to a lack of evidence about their efficacy. The benefits of non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain in the acute phase are broadly accepted but their use in chronic tendon-related diseases is controversial [ 6 ].…”

Advanced Nanofiber-Based Scaffolds for Achilles Tendon Regenerative Engineering

“…Hence, the AT is the most injured tendon in the body, accounting for approximately 40% of all tendon ruptures ( Veronesi et al, 2020 ). In the adult population (21–60 years), the incidence of AT injuries is approximately 2.35 per 1,000 people ( Darrieutort-Laffite et al, 2020 ).…”

A Novel Class of Dual-Acting DCH-CORMs Counteracts Oxidative Stress-Induced Inflammation in Human Primary Tenocytes

“…Oxidative stress endurance and, consequently, inflammation occurrence, are considered the major factors causing the failure of tendon healing in clinical practice and can lead to chronic pain and disability. Moreover, the benefits of non-steroidal anti-inflammatory drug (NSAID)-based therapy in the acute phase are broadly accepted, but their use in chronic tendon-related diseases is still controversial [ 28 ]. Therefore, an innovative therapeutic approach for the treatment of tendon-derived diseases is urgently needed, as their therapeutic management remains a challenge.…”