Partial Achilles Tendon Rupture Research Articles

Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy.

The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT. To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity. Cohort study (diagnosis); Level of evidence, 3. The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests. The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001). The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

Platelet-rich Plasma Injection for the Treatment of Partial Achilles Tendon Rupture: A Case Report

Introduction: Achilles tendon rupture is one of the most common adult tendon injuries and continues to increase in incidence. This case report outlines a comprehensive approach for stand-alone leukocyte-poor platelet-rich plasma treatment of a partial subacute Achilles tendon rupture in a professional athlete who had received prior autologous conditioned serum injections with an interleukin-1 receptor antagonist. Patient History: A 32-year-old male professional ice hockey player presented with persistent left ankle pain approximately seven months after suffering a partial acute Achilles tendon tear. Imaging confirmed a subacute partial Achilles tendon rupture. Injection: Following local anesthesia, a 25-gauge 1.5-inch needle was advanced to the target structure under ultrasound guidance and 3 mL of autologous platelet-rich plasma was divided amongst several areas of the patient's Achilles tendon, while simultaneously tenotomizing the tendon. No complications were observed. Imaging: Follow-up magnetic resonance imaging approximately 9 months after platelet-rich plasma injection revealed complete resolution of the Achilles tendon rupture. Conclusion: Ultrasound-guided leukocyte-poor platelet-rich plasma injection could be considered an effective treatment option for acute Achilles tendon rupture during the subacute stages of tendon healing, leading to complete radiographic resolution of the tear and enabling a return to high-level athletics.

Concomitant Partial Achilles Tendon Rupture and Lateral Luxation of the Superficial Digital Flexor Muscle Tendon in a Dog

AbstractThe aim of this study was to report a posttraumatic partial Achilles tendon (AT) rupture associated with lateral luxation of the superficial digital flexor tendon (SDFT) in a Whippet. This article is a brief communication. A Whippet was presented with posttraumatic plantigrade stance and non-load-bearing lameness of the right pelvic limb. The objective findings consisted in partial AT rupture and SDFT lateral luxation. Surgical treatment ensued: tenorrhaphy of the torn tendons and calcaneo-tibial screw insertion for tarsal immobilization, followed by suturing of the SDFT retinaculum. A casting bandage was employed for additional immobilization. Nonetheless, a bandage complication prompted the premature removal of the fixation screw and casting wrap. Complete functional recovery was achieved by the 20th postoperative week. The simultaneous occurrence of SDFT luxation and partial AT tear has not been reported in the literature before. The long-term postoperative functional outcome was highly satisfactory.

Partial Achilles Tendon Rupture-A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options.

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities.

Hronična parcijalna ruptura Ahilove tetive - transfer tetive flexor hallucis longus - prikaz dva slučaja

Achilles tendon injuries most commonly occur in athletes, but also in the middle-aged population practicing recreational sports. The aetiology of injury and disease of the Achilles tendon has not been completely clarified. While acute injury can be attributed to trauma, research showed that a chronic degenerative process is present in most ruptures. While there are still a lot of dilemmas when it comes to treating acute rupture, chronic rupture and disease are predominantly treated operatively. Many operative procedures can be used when treating chronic Achilles tendon diseases, such as excision of degenerative changes and tendon decompression, reconstruction using fascia lata and VY plastics, tendon transfer (Flexor Hallucis Longus - FHL, Flexor Digitorum Longus - FDL, Peroneus Brevis - PB) and allograft and synthetic graft reconstruction. The objective of the paper was to present the results of treating chronic partial Achilles tendon rupture by scar excision and FHL tendon transposition. The patients were one professional and one recreational athlete, both of whom were treated nonoperatively for a long time. They were both tested using AOFAS and ATRS tests preoperatively and postoperatively. The results showed a significant improvement of function and both patients were able to return to their usual activities. Postoperative results of AOFAS and ATRS tests were almost identical to the result on the uninjured leg. Our little series, as well as a lot of research performed by other authors, shows that an FHL tendon transposition is a safe and efficient method in treating diseases and injuries of the Achilles tendon.

Design of a Functional Splint for Rehabilitation of Achilles Tendon Injury Using Advanced Manufacturing (AM) Techniques. Implementation Study.

The use of conventional immobilization splints can cause a lot of mishaps and discomfort in patients. In addition, it is common the generation of muscle, joint and vascular complications arising from the application of classic restraint devices in this phase of treatment. Currently, it is being observed that these problems could be solved with the use of Advanced Manufacturing techniques based on Additive Manufacturing (AM), industrial digitalization and reverse engineering for the realization of individualized immobilization splints. The present study proposes to give these splints a functional character in their design adapting them to a specific pathology, in this case to the partial rupture of Achilles tendon. It also provides a comparison against the use of conventional plaster splints as an improvement factor for their definitive implementation considering the initial sanitary use for which they were designed. In this way, there have been created therapeutic windows that allow the application of rehabilitation techniques, being the treatment that would be carried out developed in parallel. The designed splint has been made in FilaFlex and Polycarbonate, materials that guarantee comfort and resistance at the same time. In addition, an optimization in terms of material has been executed, lightening the splint and reducing environmental impact and manufacturing costs. As a result of this preliminary study, a prototype on scale printed in PLA has been generated.

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

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). 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. 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). 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. IV.

Case report of a double spontaneous rupture: Quadriceps tendon and contralateral Achilles tendon

Uni- or bilateral quadriceps tendon ruptures are rare (1.37/100,000 person-years), those of the Achilles tendon are more common (21.5/100,000 person-years). To our knowledge, concomitant combination of these two ruptures has not been reported in the literature. This case reports a spontaneous rupture of quadriceps tendon and of Achilles contralateral tendon. 54 years, athletic patient without comorbidity, known for a ruptured left quadriceps tendon two years ago. During a ski descent, he presents a complete spontaneous rupture of the right quadriceps tendon and partial rupture of the left Achilles tendon, both repaired surgically. A stationary environment rehabilitation allowed a full recovery. Risk factors known in the literature for these tendon ruptures [1] , [2] (age, certain medications, anabolic steroids, certain systemic diseases, obesity, corticosteroid injections, static disorders in the knee or ankle, previous surgery) have not been found for this patient. The usually described triggers mechanisms could be found in this case (eccentric quadriceps contraction, sudden contraction of the sural triceps), occurring on tendons potentially weakened by repetitive microtrauma caused by intensive sport. However, this double spontaneous rupture and the previous rupture of the contralateral quadriceps tendon 2 years ago are suggestive of tendon abnormalities. In case of repetition, an histological analysis of the ruptured tendon could be achieved to assess the organization and structure of collagen fibers, tenocytes and microvascularization [3] . The search for a COL5A1 polymorphism also seems interesting because it has been associated with spontaneous tendon ruptures [3] , [4] .

Intraoperative Value of the Thompson Test

The purpose of the present study was to assess the validity of the Thompson sign and determine whether the deep flexors of the foot can produce a falsely intact Achilles tendon.Ten unmatched above-the-knee lower extremity cadaveric specimens were studied. In group 1, the Achilles tendon was sectioned into 25% increments. The Thompson maneuver was performed after each sequential sectioning of the Achilles tendon, including after it had been completely sectioned. If the Thompson sign was still intact after complete release of the Achilles tendon, we proceeded to release the tendon, and tendon flexor hallucis longus, flexor digitorum longus, and posterior tibial tendons. The Thompson test was performed after the release of each tendon. In group 2, the tendon releases were performed in a reverse order to that of group 1, with the Thompson test performed after each release. In group 1, the Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the tendon. After complete (100%) release of the tendon, the Thompson sign was absent in all specimens. In group 2, the Thompson sign remained intact after sectioning of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons in all specimens. The Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the Achilles tendon. After complete release of the tendon, the Thompson sign was absent in all specimens.The Thompson test is an accurate clinical test for diagnosing complete Achilles tendon ruptures. However, it might not be a useful test for diagnosing partial Achilles tendon ruptures. Our findings also call into question the usefulness of the Thompson test in the intraoperative setting.

Mast Cell Curve-Response in Partial Achilles Tendon Rupture After 830 nm Phototherapy

The aim of this study was to quantify mast cells at different time intervals after partial Achilles tendon rupture in rats treated with low-level laser therapy (LLLT). There is a high incidence of lesions and ruptures in the Achilles tendon that can take weeks and even months to heal completely. As the mast cells help in the healing repair phase, and LLLT has favorable effects on this tissue repair process, study of this modality on the quantity of mastocytes in the ruptured tendon is relevant. Sixty Wistar rats were subjected to partial Achilles' tendon rupture by direct trauma, randomized into 10 groups, and then divided into the group treated with 80 mW aluminum gallium arsenide infrared laser diode, continuous wave, 2.8 W/cm(2) power density, 40 J/cm(2) energy density, and 1.12 J total energy, and the simulation group. Both the groups were subdivided according to the histological assessment period of the sample, either 6 h, 12 h, 24 h, 2 days, or 3 days after the rupture, to quantify the mastocytes in the Achilles' tendon. The group subjected to LLLT presented a greater quantity of mastocytes in the periods of 6 h, 12 h, 24 h, 2 days, and 3 days after rupture, compared with the simulation groups, but differences were detected between the sample assessment periods only in the simulation group. LLLT was shown to increase the quantity of mastocytes in the assessment periods compared with the simulation groups.

Paper # 77: Histhopathologic Findings in Partial Achilles Tendon Ruptures

The surgical findings and histopathology are reported in 217 patients (49 females and 168 males, age: 18-66, 70% professional or amateur athletes) with Achilles tendon ruptures. We analysed and compared the history of those patients, taking into consideration following aspects: first onset of symptoms, aggravating and relieving factors, duration of symptoms, previous treatment, injections, clinical examination (local Achilles deformity, pain localisation, gastro-soleus muscle development/atrophy, biomechanical evaluation). All of the patient had US examination. There were 42 cases (19,35%) of partial ruptures. Samples for histopathological examination were always taken from clinically symptomatic and macroscopically injured parts of the tendon. In all cases (both complete and partial rupture) histopathologic picture was similar. Intraoperative evaluation of partial injures always revealed changes within one (in some cases in two) bundles of Achilles tendon. In all cases we could point the bundle with the biggest or asymetrical load and that we believe is the main factor for partial Achilles tendon injury. On the other hand histopathologic evaluation revealed: micro-injuries, fatty metaplasia, degenerative tendon-like tissue and pathologic vessels, but no inflammatory process and no potential for self healing. Mean follow-up is 3 years. In conclusion, on bases of our experience, outcomes and surgical as well as histopathological findings we believe that: Partial rupture of Achilles tendon may be a result of acute injury or a consequence of repeated microinjuries. There are three bundles of Achilles tendon and force transmission direction of each bundle is different. Acute partial Achilles tendon injuries occur during excessive asymmetric loading of the tendon. The injury occurs in the most loaded bundle. Clinically in our study, it is most often the bundle running from the medial head of gastrocnemius muscle or from the soleus muscle. Chronic processes may also be a result of overload (repetitive microtrauma) of one of the Achilles tendon bundles. The goal of operative treatment is to restore full biomechanical function of the tendon (or as similar to physiology as possible) and to restore the ability to correct transmission of contractile forces, which is possible only by careful reconstruction of the three-bundle structure of Achilles tendon. Surgical treatment has also another purpose - to enhance healing process, which in histopathologic examination has been proven to be very limited.

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images.

Repair of Insertional Achilles Tendinosis With a Bone-Quadriceps Tendon Graft

While conservative treatment may be successful in most cases, partial rupture at the calcaneal insertion point is a significant concern with insertional Achilles tendinopathy. We report on the outcomes of a surgical technique for Achilles tendon augmentation using a bone-tendon graft harvested from the knee extensor system. Our retrospective case series includes 25 surgical procedures performed in 24 patients, 19 males and five females, with a mean age of 47 (range, 30 to 59) years, 18 of whom were athletes. The mean followup period was 52 (range, 12 to 156) months. All patients underwent MRI examination prior to surgery which showed partial Achilles tendon rupture. The Achilles tendon was debrided through a posterolateral approach. The bone-quadriceps tendon graft was harvested, then the bone plug of the graft was inserted into a blind tunnel drilled into the calcaneus and fixed with an interference screw. The fibers of the quadriceps tendon were sutured to the residual part of the Achilles tendon with the foot at an angle of 90 degrees. Patients were able to resume their sporting activity after an average of 6.7 months. At last followup examination, physical activity was scored 5.2 on the 10-point Tegner Scale; the mean AOFAS score was 98.4. MRI examination showed good graft integration 1 year postoperatively. The bone-quadriceps tendon grafting technique was a good alternative for the insertional Achilles lesions with partial detachment which we felt required augmentation.

Partial mid-portion Achilles tendon ruptures: new sonographic findings helpful for diagnosis

BackgroundPartial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain and/or relative weakness in plantar flexion force is an indicator. The most...

MRI findings of achilles tendon rupture

Objective To evaluate the MRI findings of achilles tendon rupture.Methods The MRI data of 7 patients with achilles tendon rupture were retrospectively analysed.All 7 patients were male with the age ranging from 34 to 71 years.Routine MR scanning was performed in axial and sagittal planes,including T1WI,T2WI and a fat suppression MRI(SPIR).Results Among 7 patients,complete achilles tendon rupture was seen in 6 cases,partial achilles tendon rupture 1 case.The site of tendon disruption were 2.6-11.0 cm(mean 5.4 cm)proximal to the insertion in the calcaneus.The MRI findings of a partial or complete rupure of the achilles tendon included enlarged and thickened achilles tendon (7 cases),wavy lax achilles tendon(2 cases),discontinuity of some or all of its fibers and intratendinous regions of increased signal intensity(7 cases).In the cases of complete tendon rupture,the size of the tendinous gap varied from 3.0-8.0 mm,which was filled with blood and appeared as edema of increase signal intensity on T2WI and SPIR.In all 7 patients,MR scanning showed medium signal intensity(7 cases)on T1WI,or medium signal intensity(1 cases),medium-high signal intensity(3 cases),hish signal intensity(3 cases)on T2WI,and medium-high singnal intensity(2 eases),high signal intensity(5 cases)on fat suppression MRI.The preachilles fat pad showed obscure in 6 cases of complete achilles tendon rupture.Conclusion MRI is an excellent method for revealing achilles tendon rupture and confirming the diagnosis. Key words: Achilles tendon; Wounds and injuries; Magnetic resonance imaging

The value of MRI in diagnosis of Achilles tendon rupture

目的 探讨磁共振成像(MRI)在闭合性跟腱损伤中的诊断价值,包括判断损伤性质、损伤程度和疗效随访.方法2003年4月～2005年5月24例闭合性跟腱断裂伤患者经低场强MRI扫描,MRI采用矢状面T1WI、T2WI、GE-STIR和横断面TME,层厚和层距各为4 mm.并根据MRI分级诊断标准确定是部分性损伤还是完全性损伤.其中4例4～8周后复查MRI.结果MRI能准确判断跟腱撕裂的程度、部位,跟腱撕裂主要发生在跟腱中部.16例跟腱完全断裂患者在所有序列上显示跟腱连续性中断,跟腱增粗,T2WI断端间呈高信号;8例跟腱部分断裂患者T2WI显示条状高信号.术后随访4例患者见跟腱变细,信号降低.结论MRI能对跟腱撕裂程度及部位做出准确判断,直接显示跟腱内的信号变化并提供丰富的信息,对临床治疗具有重要参考价值。

Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging

Objectives: The aim of this study was to determine whether ultrasound can correctly visualise partial ruptures of the proximal Achilles tendon.Method: This was a prospective study in which all chronic...

Effect of In-Ga-Al-P Diode Laser Irradiation on Angiogenesis in Partial Ruptures of Achilles Tendon in Rats

This study was conducted to analyze the effect of different irradiances of low-level laser therapy (LLLT) on angiogenesis after partial rupture of Achilles tendon of rats. Ninety-six animals were divided into three groups subject to treatment during 3, 5, and 7 days post-lesion. Thirty-two animals were used in each group. The groups were further divided into four subgroups with eight animals in each, receiving In-Ga-Al-P laser (660 nm) treatment at (1) mean output of 10 mW, (2) 40 mW during 10 sec, (3) a sham subgroup, and (4) a non-treatment subgroup. Each animal was subjected to a lesion of the Achilles tendon by dropping a 186-g weight from a 20-cm height over the tendon. Treatment was initiated 6 h post-injury for all the groups. Blood vessels were colored with India ink injection and were examined in a video microscope. Laser exposure promoted an increase in blood vessel count when compared to controls. The 40-mW group showed early neovascularization, with the greatest number of microvessels after three laser applications. The 10-mW subgroup showed angiogenesis activity around the same time as the sham laser group did, but the net number of vessels was significantly higher in the former than in the controls. After seven irradiations, the subgroup receiving 40 mW experienced a drop in microvessel number, but it was still higher than in the control groups. LLLT of different intensities seems to promote neovascularization in damaged Achilles tendons of rats after partial rupture compared to controls.

ACHILLES INJURY - RECREATIONAL ATHLETE

HISTORY - A 30-year-old athletic corrections officer felt a painful “pop” in his left heel, while sprinting, during a softball game on 5/21/00. The patient has a history of a complete right Achilles tendon rupture in January of 1999, while playing football. His right tendon was sugically repaired at that time. PHYSICAL EXAMINATION - Swelling and tenderness along the left Achilles tendon. Palpable defect 2cm above the calcaneus. Positive Thompson test. DIFFERENTIAL DIAGNOSIS Partial Achilles Tendon Rupture Complete Achilles Tendon Rupture TEST AND RESULTS NONE FINAL/WORKING DIAGNOSIS Complete left Achilles tendon rupture TREATMENT Conservative Treatment for left Achilles tendon rupture - May 2000 SLC/NWB in gravity equinus, initially SLC/NWB in partial equinus at 3 weeks post injury CAM Walker, progressive weight bearing, ROM exercises at 8 weeks Hinged CAM Walker, calf strengthing exercises at 10 weeks Heel lifts at 12 weeks Return to full activity at 16 weeks post injury. Surgical Treatment for right Achilles tendon rupture - January 1999 Surgical repair, SLC/NWB/Equinus Staples removed, SLC/NWB/dorsiflexion increased by 10 degrees at 10 days post injury SLC/NWB/dorsiflexion increased by second increment of 10 degrees at 4 weeks SLC/Weight bearing as tolerated at 6 weeks Cast removed, physical therapy at 8 weeks Light duty at 12 weeks Return to full activities at 16 weeks post injury OUTCOME The patient had equal functional results with both treatments, but preferred the conservative method over the surgical.

Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis.

OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean...