Molecular and Structural Effects of Percutaneous Interventions in Chronic Achilles Tendinopathy.

Christelle Darrieutort-Laffite,Louis J Soslowsky,Benoit Le Goff

doi:10.3390/ijms21197000

Christelle Darrieutort-Laffite, Louis J Soslowsky + Show 1 more

Open Access

https://doi.org/10.3390/ijms21197000

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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.

Highlights

Tendon pathologies are a common problem, especially in athletes and in people of working age, as well as in elderly patients
Injected treatments or dry needling show promising results in animal models, further studies are needed in humans to determine their position in the therapeutic strategy of Achilles tendinopathy
Similar to platelet-rich plasma (PRP), results seem interesting in animal models, effects on pain and function are not superior to placebos in the randomized clinical trials

Summary

Introduction

Tendon pathologies are a common problem, especially in athletes and in people of working age, as well as in elderly patients. Rotator cuff tendinopathies and Achilles tendinopathies (AT) are the most frequent locations. Pain is the main reported symptom; it is often chronic and has an impact on the work and daily life of patients. The management of musculoskeletal pathologies represents a major societal burden [2]. Intrinsic factors include architectural disorders of the foot and more general factors such as age, use of corticosteroids, obesity or intake of fluoroquinolones [3]. The main extrinsic factor is mechanical overload responsible for micro-traumatic lesions

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