Chronic Mid-portion Achilles Tendinopathy Research Articles

Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy?

To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. Prospective cohort study, secondary analysis of data from a randomized trial. Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment-Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0-100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment-Achilles scores) were determined using a Mixed Linear Model. 80 patients were included. The mean Victorian Institute of Sports Assessment-Achilles score improved 20 points (95 % confidence interval, 16-25, P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β -0.2; 95 % confidence interval: -0.4 to -0.1; P < .001, Visual Analogue Scale-10-hops: β -0.3; 95 % confidence interval: -0.4 to -0.2; P < .001) and the change in the Victorian Institute of Sports Assessment-Achilles score. In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.

Return to Sports and Functional Outcomes after Autologous Platelet-Rich Fibrin Matrix (PRFM) and Debridement in Midportion Achilles Tendinopathy: A Case Series with 24-Month Follow-Up

(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months.

An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study.

Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Average VISA-A improvements of 26.9 points (P=0.004) and 35.4 points (P=0.006) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0-10) was reduced from 5.5 to 2.5 (P < 0.001). Color Doppler ultrasound activity (0-4) was reduced by 50%, from an average of grade 2 to grade 1 (P=0.023). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% (P=0.001). Tendon thickness showed no statistically significant change (P=0.415). Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.

Do High-Volume Injections Affect the Ultrasonographic Neovascularization in Chronic Achilles Tendinopathy? A Randomized Placebo-Controlled Clinical Trial.

High-volume injections (HVIs) are thought to target neovascularization in chronic midportion Achilles tendinopathy (AT), yet the mechanism has not been clarified. Therefore, we aim to evaluate whether a HVI decreases ultrasonographic Doppler flow in patients with chronic midportion AT. A double-blind, randomized, placebo-controlled clinical trial. Sports medicine department at a district general hospital. Sixty-two patients with clinically diagnosed chronic midportion AT were included and randomized into the intervention group (HVI-group, n = 30) and placebo group (n = 32). A daily calf-muscle exercise program combined with either (1) a HVI (HVI-group: 50 mL) or (2) a placebo-injection (placebo-group: 2 mL) with a mixture of saline and lidocaine. Primary outcome was the surface area quantification (SAQ) score (%) of the Doppler flow during a 24-week follow-up period. Secondary outcome was the association between SAQ scores and symptoms [Victorian Institute of Sports Assessment-Achilles (VISA-A)]. Outcomes were measured before, directly after, and 1 hour after the injection and at 2, 6, 12, and 24 weeks of follow-up. There was no significant between-group difference at 24 weeks [-0.1%; 95% confidence interval (CI), -4.9 to 4.7] or at any of the other time points. Change in SAQ score did not correlate with the change in VISA-A score (P = 0.93). A HVI does not affect Doppler flow in patients with chronic midportion AT. Also, changes in Doppler flow were not associated with the clinical outcome. These findings challenge the theoretical basis of a HVI. NCT02996409.

Recreational athletes with mid-portion Achilles tendinopathy: A comparison of maximal and explosive plantarflexion strength between symptomatic and asymptomatic sides

Purpose: For recreational athletes with chronic mid-portion Achilles tendinopathy, is there a difference between the symptomatic and asymptomatic side, for maximal and explosive plantarflexion strength. An exploratory study.

Runners with chronic mid-portion Achilles tendinopathy have greater Triceps surae intracortical inhibition than healthy controls

Background: Achilles tendinopathy (AT) is an overload injury, affecting mostly runners. Persistent triceps surae muscle weakness has been reported in AT patients. Muscle force is influenced by inhibitory and excitatory circuits, and imbalances between these (e.g., increased short-interval intracortical inhibition - SICI) may negatively affect strength. Increased SICI has been observed with patella tendinopathy; however, it is unclear if this increased inhibition is present in chronic mid-portion AT patients. Thus, this study aimed to investigate the intracortical inhibitory mechanisms in runners with mid-portion AT. Methods: Runners with chronic mid-portion AT (n=11; 44.1±8.4 years) and healthy controls (n=13; 33.9±4.25 years), with a running routine of at least twice weekly for more than 4 months, were recruited. All completed the VISA-A questionnaire AT (AT= 70.7±7.0) and Control (100±0). The most symptomatic leg (8 unilateral AT and 3 bilateral AT) was compared with control group dominant legs. Plantar flexor maximal voluntary isometric contraction (MVIC) torque was measured via isokinetic dynamometer (knee fully extended, ankle at 0°). Triceps surae endurance was measured with standing single leg heel raise to failure (SLHR) test. SICI was assessed using paired-pulse transcranial magnetic stimulation to the motor cortex area associated with the leg, delivering 20 paired-pulses at 0.8x (first pulse) and 1.2x (second pulse) of active motor threshold (AMT) with 3ms interval and 20 single pulse stimulation at 1.2 AMT, all during a 10% plantar flexion contraction. Two-way repeated measures ANOVA was used to compare SICI between muscles (Soleus, and Gastrocnemii) and groups. Independent t-test was used to compare SLHR and MVIC peak torque between groups. Results: SICI was higher in AT group (67.4±9.0) than controls (54.0±9.0); (p=0.039,) independent of the tested muscle (no muscle vs group interaction; p =0.828). AT group performed ~28% fewer SLHR repetitions than the controls (AT, 27.5.0±6.8 and control 38.5±5.3 repetitions, p=0.004). There was no difference in MVIC peak torque corrected for body mass (N.m/Kg), (AT=1.4±0.3; Control=1.6±0.4, p =0.093). Discussion: The AT group displayed greater intracortical inhibition of the triceps surae muscles and reduced SLHR endurance, without deficit in maximal isometric torque. SICI could be negatively influencing SLHR endurance in AT; thus, rehabilitation aiming to reduce intracortical inhibition should be considered for better outcomes. Conflict of interest: The authors declare no conflict of interest related to the present work.

A criteria-based rehabilitation program for chronic mid-portion Achilles tendinopathy: study protocol for a randomised controlled trial

BackgroundAchilles tendinopathy (AT) is a common overuse injury in running-related sports where patients experience pain and impaired function which can persist. A graded rehabilitation program has been successful in reducing pain and improving function to enable a return to sport. The aim of this study is to compare the effectiveness of a criteria-based rehabilitation program including strength and reactive strength targets, with a previously successful rehabilitation program on changes in pain and function using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Secondary aims will be to assess changes in calf strength, reactive strength, and lower limb running and forward hop biomechanics over the course of a 12-week rehabilitation program, and long-term follow-up investigations.MethodsSixty eligible participants with chronic mid-portion AT who train in running-based sports will be included in this study. They will be randomly assigned to a group that will follow an evidence-based rehabilitation program of daily exercises with progression guided by symptoms or a group performing 3 high-intensity rehabilitation sessions per week with individualised load targets progressing to reactive strength exercises. Testing will take place at baseline, week 6 and 12. Plantar flexor peak torque will be measured using isokinetic dynamometry, reactive strength will be measured using a drop jump and lower limb biomechanical variables will be measured during a single leg forward hurdle hop test and treadmill running using 3D motion analysis. Follow-up interviews will take place at 6, 12 and 24 months after beginning the program which will assess patient participation in sport and possible re-injury.DiscussionThis is the first study to propose an individualised criteria-based graded rehabilitation program in patients in with chronic mid-portion Achilles tendinopathy where progression is guided by strength and reactive strength outcome measures. This study will provide a comprehensive assessment of plantar flexor strength, reactive strength and lower limb biomechanical variables in running and forward hopping with the VISA-A questionnaire as the primary outcome measure and long term post-intervention follow-up assessments performed.Trial registrationClinicalTrials.gov (ID: NCT04384874). Registered retrospectively on April 23rd 2020.

Are pain coping strategies and neuropathic pain associated with a worse outcome after conservative treatment for Achilles tendinopathy? A prospective cohort study

ObjectivesTo analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients. DesignProspective cohort study. MethodsPatients with clinically-diagnosed chronic midportion AT were conservatively treated. At baseline, the Pain Coping Inventory (PCI) was used to determine scores of coping, which consisted of two domains, active and passive (score ranging from 0 to 1; the higher, the more active or passive). Presence of neuropathic pain (PainDETECT questionnaire, −1 to 38 points) was categorized as (a) unlikely (≤12 points), (b) unclear (13–18 points) and (c) likely (≥19 points). The symptom severity was determined with the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (0–100) at baseline, 6, 12 and 24 weeks. We analysed the correlation between (1) PCI and (2) PainDETECT baseline scores with change in VISA-A score using an adjusted Generalized Estimating Equations model. ResultsOf 80 included patients, 76 (95%) completed the 24-weeks follow-up. The mean VISA-A score (standard deviation) increased from 43 (16) points at baseline to 63 (23) points at 24 weeks. Patients had a mean (standard deviation) active coping score of 0.53 (0.13) and a passive score of 0.43 (0.10). Twelve patients (15%) had a likely neuropathic pain component. Active and passive coping mechanisms and presence of neuropathic pain did not influence the change in AT symptoms (p=0.459, p=0.478 and p=0.420, respectively). ConclusionsContrary to widespread belief, coping strategy and presence of neuropathic pain are not associated with a worse clinical outcome in this homogeneous group of patients with clinically diagnosed AT.

High volume distension injection (HVDI) for chronic mid-portion Achilles tendinopathy: A service evaluation of clinical outcomes

Purpose: High Volume Distension Injection (HVDI) is a treatment adjunct in chronic mid-portion Achilles tendinopathy. This study analysed whether HVDI is safe and effective in an outpatient clinic setting. Methods: Retrospective service evaluation of 18 participants over 18 months. Ultrasound-guided saline, corticosteroid and bupivacaine was injected to disrupt vasculo-neural ingrowth, with post-procedure eccentric exercises. Mean follow-up was 8 weeks. Outcomes used were Numeric rating Scale (NRS) of pain, tendon thickness and Modified Ohberg score (MOS) of neovascularisation measured on Ultrasound and Doppler imaging. Results: Mean reduction in NRS was 5.30 ± 2.53 ( P &lt; 0.001). Mean tendon thickness reduction was 0.21 ± 0.17 cm ( P &lt; 0.001). Median MOS improved from 2.00 ± 2.00 to 1.00 ± 3.00 ( P = 0.009). No complications occurred. 11 participants had successful primary HVDI, 3 responded to a second injection. Two non-responders were referred for surgery and two referred for alternative therapy by patient preference. Conclusion: Significant reduction in pain, tendon thickness and neovascularity was observed in 78% of patients. Recurrence in 39%. HVDI with eccentric training is safe and effective intervention in outpatient clinic setting.

The effect of high-volume image-guided injection in the chronic non-insertional Achilles tendinopathy: a retrospective case series

PurposeTo evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic mid-portion Achilles tendinopathy (AT) improve function and reduce pain at 12-months follow-up.MethodsPatients with resistant mid-portion AT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and 12 months. A standardized eccentric rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Achilles tendon questionnaire (VISA-A) and statistically analyses were performed.ResultsThe study included 30 single treatment HVIGI procedures in AT in 28 patients (23 men, 5 women) with a mean age of 45.1 (range 16–63). The mean duration of symptoms before HVIGI was 37 months. The baseline VISA-A score of 50 ± 15 (range 14–74) improved to 61 ± 21 (range 31–94) after 1 year (p = 0.04). Of the 30 AT procedures 10 patients (11 AT) were not satisfied after the initial HVIGI procedure. Of these, 8 patients (9 AT) needed additional HVIGI and two patients needed surgery. Of the remaining 18 patients (19 AT), 10 patients had more than a 10-point improvement in the VISA-A score after 1 year.ConclusionsIn this retrospective case-study, only 10 patients (33%) did benefit of a single HVIGI treatment at 12-months and an 11-point significant improvement was seen at on the VISA-A score.

Ultrasound Imaging of the Abdominal Wall and Trunk Muscles in Patients with Achilles Tendinopathy versus Healthy Participants.

Purpose: To compare and quantify with ultrasound imaging (USI) the inter-recti distance (IRD), rectus abdominis (RA), external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and multifidus thickness and the RA and multifidus cross-sectional area (CSA) between individuals with and without chronic mid-portion Achilles tendinopathy (AT). Methods: A cross-sectional study. A sample of 143 patients were recruited and divided into two groups: A group comprised of chronic mid-portion AT (n = 71) and B group composed of healthy subjects (n = 72). The IRD, RA, EO, IO, TrAb, and multifidus thickness, as well as RA and multifidus CSA, were measured by USI. Results: USI measurements for the EO (p = 0.001), IO (p = 0.001), TrAb (p = 0.041) and RA (p = 0.001) thickness were decreased as well as IRD (p = 0.001) and multifidus thickness (p = 0.001) and CSA (p = 0.001) were increased for the tendinopathy group with respect the healthy group. Linear regression prediction models (R2 = 0.260 − 0.494; p < 0.05) for the IRD, RA, EO, and IO thickness (R2 = 0.494), as well as multifidus CSA and thickness were determined by weight, height, BMI and AT presence. Conclusions: EO, IO, TrAb, and RA thickness was reduced and IRD, multifidus thickness and CSA were increased in patients with AT.

Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method?

ObjectivesUltrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0–4+) has higher reliability than a quantified measure of Doppler flow (0–100%). The purpose of this cross‐sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy.MethodsTwo observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score.ResultsIn total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58–0.91), compared to 0.64 (95% confidence interval, 0.45–0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points.ConclusionsThe SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcomes the ceiling effect of the modified Öhberg score. Future research should focus on the relationship between the SAQ method and clinical outcomes and use this method to monitor treatment responses.

Intrinsic foot muscles morphological modifications in patients with Achilles tendinopathy: A novel case-control research study

ObjectiveTo compare the thickness and cross-sectional area (CSA) of the Abductor Hallucis Brevis (AHB), Flexor Digitorum Brevis (FDB) and Flexor Hallucis Brevis (FHB) in subjects with and without chronic mid-portion Achilles tendinopathy (AT). DesignA case-control research study. SettingA private clinic. ParticipantsA total sample of 143 subjects was recruited for the study and divided in two groups, such as chronic mid-portion AT group (n = 71) and healthy group (n = 72). Main outcome measuresUltrasound B-Mode imaging was used to measure the thickness and CSA of the AHB, FDB and FHB in subjects with and without chronic mid-portion AT at rest. ResultsUSI measurements of the AHB (p < .001) and FDB (p < .001) thicknesses, as well as FDB (p = .005) and FHB CSA (p = .048), were increased for the tendinopathy group with respect to healthy group. However, FHB muscle thickness (p < .001) increases were showed for the control group with respect the tendinopathy group. ConclusionsUSI measurements of ABH and FDB thicknesses, as well as FDB and FHB CSA, were increased in patients who suffered from AT with respect to healthy group.

Ultrasonography effectiveness of the vibration vs cryotherapy added to an eccentric exercise protocol in patients with chronic mid-portion Achilles tendinopathy: A randomised clinical trial.

Tendinopathy is a very common disease in the general population as well as in athletes. The aim of the present study was to examine the tendon thickness and cross-sectional area (CSA) in subjects with chronic mid-portion Achilles tendinopathy (AT) who engaged in either an eccentric exercise (EE) programme with vibration training or an EE programme combined with cryotherapy. A sample of 61 patients with chronic mid-portion AT were recruited and divided into two groups: EE programme vibration training (n = 30) and EE programme combined with cryotherapy (n = 31). Three ultrasound assessments were performed: pre-intervention and at 4, and at 12 weeks. The comparison of thickness and CSA measures at baseline, 4, and 12 weeks showed a significant (P < 0.05) increase at 0, 2, 4, and 6 cm in maximal isometric contraction and at rest in subjects with chronic mid-portion AT. The EE vibration training resulted in a statistically significant CSA increase compared with the cryotherapy group in patients with chronic mid-portion AT.

Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients.

The current pilot study investigates whether oral supplementation of specific collagen peptides improves symptoms and tendon vascularisation in patients with chronic mid-portion Achilles tendinopathy in combination with structured exercise. Participants were given a placebo or specific collagen peptides (TENDOFORTE®) in combination with a bi-daily calf-strengthening program for 6 months. Group AB received specific collagen peptides for the first 3 months before crossing over to placebo. Group BA received placebo first before crossing over to specific collagen peptides. At baseline (T1), 3 (T2) and 6 (T3) months, Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaires and microvascularity measurements through contrast-enhanced ultrasound were obtained in 20 patients. Linear mixed modeling statistics showed that after 3 months, VISA-A increased significantly for group AB with 12.6 (9.7; 15.5), while in group BA VISA-A increased only by 5.3 (2.3; 8.3) points. After crossing over group AB and BA showed subsequently a significant increase in VISA-A of, respectively, 5.9 (2.8; 9.0) and 17.7 (14.6; 20.7). No adverse advents were reported. Microvascularity decreased in both groups to a similar extent and was moderately associated with VISA-A (Rc2:0.68). We conclude that oral supplementation of specific collagen peptides may accelerate the clinical benefits of a well-structured calf-strengthening and return-to-running program in Achilles tendinopathy patients.

Results of minimally invasive Achilles tendon scraping and plantaris tendon removal in patients with chronic midportion Achilles tendinopathy: A longer-term follow-up study.

Background:Treatment with ultrasound and colour Doppler–guided minimally invasive Achilles tendon scraping and plantaris tendon removal has shown promising short-term results in patients with chronic painful midportion Achilles tendinopathy.Methods:In a follow-up study, 182 consecutive patients (241 tendons) who had undergone Achilles tendon scraping and plantaris tendon removal were contacted on telephone by an independent investigator. The patients who answered the telephone call were included, and they answered a questionnaire on telephone and then also sent their written answers. The questionnaire included information about patient satisfaction with the result of the treatment, time to return to full Achilles tendon loading activity, and a pain score (Visual Analogue Scale-VAS).Results:The follow-up period was 5.8 years (mean) (range of 2–13 years) after surgery. Altogether, 110 patients (136 Achilles tendons), 52 years (mean)(range 18-73) old at surgery could be reached and were included. In total, 81 tendons were operated with the Achilles scraping procedure alone, and for 55 Achilles operations also a plantaris tendon removal was performed. For 93% of the operated tendons, the patients were satisfied with the surgical outcome and the VAS had decreased from 74 preoperatively to 8 postoperatively. Nine male patients (9 tendons), five operated with scraping + plantaris removal, had remaining tendon pain during loading and were not satisfied. Their VAS score ranged from 22 to 91. For 21% of the operated tendons, some occasional mild discomfort not preventing from full tendon loading, was reported. There were no differences in pain reduction and satisfaction rates between men and women, and between Achilles scraping alone and scraping plus plantaris removal.Conclusion:Ultrasound and colour Doppler–guided surgical Achilles tendon scraping and plantaris tendon removal in patients with chronic painful midportion Achilles tendinopathy show remaining good clinical outcomes and high satisfaction rates in this longer-term follow-up.

Comparison of the sonographic features of the Achilles Tendon complex in patients with and without achilles tendinopathy: A case-control study

AimThe aim of the present study was to evaluate and quantify with ultrasound imaging (USI) the Achilles tendon thickness, cross-sectional area (CSA), Kager's fat pad length and gastrocnemius-soleus pennation angle (PA) between chronic mid-portion Achilles tendinopathy (AT) and healthy subjects. MethodsA total sample of 143 individuals (age: 41.3 ± 12.0 y; height: 1.74 ± 0.0 m; weight: 75.0 ± 11.4 kg; body mass index, BMI: 24.4 ± 2.6 kg/m2) was recruited and divided in two groups: chronic mid-portion AT group (n = 71) and a healthy group (n = 72). ResultsThe thickness and CSA at 4 cm and 6 cm from the calcaneus was increased showing statistically significant differences (P < .01) in favor the tendinopathy group. For the gastrocnemius-soleus PA and Kager's fat pad length, significant differences (P < .01) were observed for a decrease in favor of the tendinopathy group. ConclusionsThis study reported an increase of Achilles tendon thickness and CSA at 4 cm and 6 cm from the calcaneus as well as a decrease in gastrocnemius-soleus PA and Kager's fat pad length in patients with chronic mid-portion AT.

Effectiveness of Eccentric Exercise and a Vibration or Cryotherapy Program in Enhancing Rectus Abdominis Muscle Thickness and Inter-Rectus Distance in Patients with Chronic Mid-Portion Achilles Tendinopathy: A Randomized Clinical Trial.

Purpose: Abdominal muscles are key in maintaining body stability and balance and an improvement in the functioning of these muscles could influence the rehabilitation process in lower limb pathologies such as Achilles Tendinopathy (AT). The aim was to explore whether calf eccentric exercise (EE) with vibration training was more effective at causing adaptation to the rectus anterior (RA) thickness and inter-rectus distance (IRD) than calf EE with cryotherapy.Methods: The investigation was a single-blinded, randomized, controlled clinical trial (NCT03515148). Sixty-one individuals diagnosed with mid-portion AT were recruited and divided in two groups: group A (n = 30) followed an EE with vibration program and group B (n = 31) an EE program with cryotherapy, for 12-weeks. RA muscle thickness and IRD were measured in maximal isometric contraction and at rest as an indication of superficial abdominal muscle activation.Results: IRD measures showed a significant (P < 0.05) decrease at baseline, 4 and at 12-weeks in both groups, but no significant differences were observed between the intervention groups. RA thickness was significantly increased (P < 0.05) in measures at baseline, 4 and 12-weeks showed a significant increase in maximal isometric contraction and at rest in favor of the EE vibration program group.Conclusions: The present study showed a RA thickness increase in both groups in favor of the EE vibration program with respect to cryotherapy added to EE in short and mid term in maximal isometric contraction and at rest in subjects with chronic mid-portion AT. IRD was decreased in both groups without between-groups differences.

Electromagnetic Transduction Therapy for Achilles Tendinopathy: A Preliminary Report on a New Technology

A parallel prospective feasibility study was performed on 53 patients with chronic mid-portion Achilles tendinopathy (age 44.7 ± 9.1 years). Of the 53 patients, 28 (active group) were treated using a new electromagnetic (pulsed electromagnetic field) transduction therapy device (Cellactor® MT1) and heel cushions. The device produces an electromagnetic field of 80 milliTesla; a total of 8 treatments was performed within 4 weeks in an outpatient setting, without anesthesia, immobilization, or rest. A control group of 25 patients with a similar duration of symptoms was treated with heel cushions only. At the 12-week assessment point, the visual analog scale scores in both groups had significantly decreased, although the active group had significantly improved visual analog scale scores compared with those of the controls. The Role-Maudsley scores had also significantly improved in both the active and the control groups (p < .00001 and p = .0002, respectively). Electromagnetic transduction therapy could potentially be a useful modality for the treatment of Achilles tendinopathy. It should be compared with the current reference standard of extracorporeal shockwave therapy/radial soundwave therapy with similar level I, II, and III studies.

Alfredson versus Silbernagel exercise therapy in chronic midportion Achilles tendinopathy: study protocol for a randomized controlled trial

BackgroundMidportion Achilles tendinopathy (AT) is a common overuse injury, usually requiring several months of rehabilitation. Exercise therapy of the ankle plantar flexors (i.e. tendon loading) is considered crucial during conservative rehabilitation. Alfredson’s isolated eccentric and Silbernagel’s combined concentric-eccentric exercise programs have both shown beneficial results, but it is unknown whether any of these programs is superior for use in clinical practice. Therefore, the primary objective of this study is to compare the effectiveness of both programs on clinical symptoms. Secondary objectives are to compare the effectiveness of both programs on quality of life and functional outcome measures, to investigate the prognostic value of baseline characteristics, to investigate differences in cost-effectiveness.Methods/DesignEighty-six recreational athletes (21–60 years of age) with unilateral chronic midportion AT (i.e. ≥ 3 months) will be included in this multicenter assessor blinded randomized controlled trial. They will be randomly allocated to either a group performing the Alfredson isolated eccentric training program (n = 43), or a group performing the Silbernagel combined concentric-eccentric program (n = 43). In the Alfredson group, participants will perform eccentric heel-drops on their injured side, twice daily for 12 weeks, whereas in the Silbernagel group, participants perform various concentric-eccentric heel-raise exercises, once daily for 12 weeks. Primary outcome measure will be the Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire. Secondary outcomes will be a visual analogue scale (VAS) for pain during daily activities and sports, duration of morning stiffness, global perceived effect, the 12-item Short Form Health Survey and the Euroqol instrument, and functional performance measured with the heel-raise test and the countermovement jump. Additionally, alongside the RCT, a cost-effectiveness analysis will be performed. Assessments will be performed at baseline and after 12, 26, and 52 weeks.DiscussionThis study is the first to directly compare the Alfredson and the Silbernagel exercise program in a randomized trial. The results can further enlarge the evidence base for choosing the most appropriate exercise program for patients with midportion AT.Trial registrationDutch Trial register: NTR5638. Date of registration: 7 January 2016.