Tendinopathy Of Achilles Tendon Research Articles

Infrared thermography in the diagnosis of Achilles tendinitis. A randomized double-blind pilot clinical trial

Background: The Achilles tendon (AT) is the widest and most resistant of the osteoarticular system and has the greatest load-bearing capacity. It is involved in daily functioning and sports activities performance. Exposure to excessive stress on the calcaneus tendon (CT) can prevent an effective repair process and favor permanent injuries. Tendinopathy is a clinical syndrome resulting from disorientation of AT fibers, and inflammatory signs characteristic of tendinitis or tissue degeneration present in tendinosis can be found. The condition can manifest itself through functional changes accompanied by clinical signs such as crackling, tenderness, pain and edema. Infrared thermography is used to trace thermographic profiles, capable of detecting thermal changes related to pathologies. Objectives: The main goal of this study was to correlate AT region thermograms with clinical and functional characteristics in healthy individuals with CT pathology. Methods: The present work consists of a double-blind pilot randomized trial, of qualitative and quantitative nature. Individuals with TC tendinopathy, classified in the Tendinopathy Group (TG) and individuals without tendinopathy, classified in the Control Group (CG) participated. Assessments were performed to characterize the subjects belonging to the TG and CG: anamnesis, infrared thermography, referred pain, crepitation and thickness on palpation, algometry, arch sign test and Royal London Hospital test, pain on passive dorsiflexion, pain on lifting the heel and long jump. Results: The results obtained in infrared thermography were consistent with those obtained in the clinical evaluation for TG and GC. The results demonstrate that healthy tendons presented an average temperature difference of 0.24 ± 0.15 ºC between legs with a maximal difference of 0.4 ºC. On the other hand, unilateral tendinopathy presented an average temperature difference of 1.2 ± 0.9 ºC, however, this difference could be as big as 5.1 ºC. Conclusion: It is concluded that infrared thermography can be used safely and non-invasively to aid in the diagnosis of Achilles tendon tendinopathy.

P072 Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain

Abstract Background/Aims Enthesitis is a hallmark clinical feature of psoriatic arthritis (PsA) with the most commonly affected site being the Achilles tendon (AT) insertion into the posterior calcaneum. There is overlap in the clinical and ultrasound (US) pathological presentation of Achilles enthesitis and Achilles tendinopathy, however their treatment guidelines differ significantly. AT pain in PsA is complex, with the potential interplay of mechanobiology and inflammation. The aim of this study was to assess the structure and function of the AT in individuals with PsA to inform the future development of a non-pharmacological intervention. Methods A single-centre, cross-sectional observational study was conducted. People with PsA with (PsA+AT) and without (PsA-AT) AT pain were age and sex-matched with healthy controls (n = 11 per group). AT structure and function were assessed by clinical examination (Leeds Enthesitis Index and AT tendinopathy tests), B-mode and Power Doppler (PD) US, the Victorian Institute of Sports Assessment - Achilles (VISA-A) questionnaire, the bilateral heel raise test and 10-metre walk test (10MWT). Patient-reported outcome measures were used to evaluate local and global disease activity, impact, and quality of life. Group membership associations and between-group differences for domains of interest were evaluated using Pearson’s Chi-squared, one-way ANOVA, Mann-Whitney or Kruskal-Wallis tests. Results All groups were comparable in terms of sex, age and BMI. PsA disease duration was longer in the PsA-AT group (mean [SD], 20.1 years [13.1]) compared to the PsA+AT group (7.4 [6.3]). Structural changes at the enthesis on US were detected in all groups; however inflammatory features were significantly more prevalent in the PsA+AT group (p<0.001). PD signal was only detected in the PsA+AT group. Mid-portion and myotendinous AT pathology, including diffuse thickening, altered echogenicity and partial tears were also present, irrespective of the presence of enthesitis. PsAID-12 and HAQ-DI scores were significantly worse in the PsA+AT compared to the PsA-AT group (p=0.018 and p=0.001, respectively). The PsA+AT group walked slower (mean=17.89 seconds for 10MWT) compared to the PsA-AT group (12.23) and controls (11.55), could perform significantly less heel raises until the point of fatigue (PsA+AT mean=19.45, PsA-AT=39.18, controls=51.55, p=0.007) and had significantly worse VISA-A scores (PsA+AT mean=33, PsA-AT=71, controls=92, p<0.001), indicative of impaired AT function. In the PsA+AT group, AT pain was persistent and disabling despite pharmacological management in line with current guidelines and <30% had received treatment from podiatry or physiotherapy services. Conclusion People with PsA and AT pain exhibit severe functional limitations as demonstrated by the bilateral heel raise test, 10MWT and VISA-A scores. The diversity of US imaging features detected, and the inconsistencies in treatment provided, highlights an opportunity to develop individualised non-pharmacological management strategies stratified by US features and performance-based testing. Disclosure A. Patience: None. M.P. Steultjens: None. S. Siebert: None. G.J. Hendry: None.

Cadaveric and Ultrasound Validation of Percutaneous Electrolysis Approach at the Achilles Tendon as a Potential Treatment for Achilles Tendinopathy: A Pilot Study.

Achilles tendon tendinopathy (AT) is a musculoskeletal condition characterized by pain in the Achilles tendon and impaired physical performance or sport activities. AT is difficult to treat, and the results are variable. Preliminary evidence suggests a positive effect for pain of percutaneous electrolysis in patients with tendinopathy. Our aim was to determine the validity and safety of a percutaneous electrolysis approach targeting the interphase between the Achilles tendon and the Kager’s fat with ultrasound imaging in both healthy individuals and on a fresh cadaver model (not ultrasound guiding). A needle was inserted from the medial to the lateral side under the body of the Achilles tendon, just between the tendon and the Kager’s triangle, about 5 cm from the insertion of tendon in the calcaneus in 10 healthy volunteers (ultrasound study) and 10 fresh cadaver legs. An accurate needle penetration of the interphase was observed in 100% of the approaches, in both human and cadaveric models. No neurovascular bundle of the sural nerve was pierced in any insertion. The distance from the tip of the needle to the sural nerve was 5.28 ± 0.7 mms in the cadavers and 4.95 ± 0.68 mms in the volunteer subjects, measured in both cases at a distance of 5 cm from the insertion of the Achilles tendon. The results of the current study support that percutaneous electrolysis can be safely performed at the Kager’s fat–Achilles tendon interphase if it is US guided. In fact, penetration of the sural nerve was not observed in any needle approach when percutaneous needling electrolysis was performed by an experienced clinician. Future studies investigating the clinical effectiveness of the proposed intervention are needed.

Primena mehaničkog udarnog talasa u lečenju kalcifikovanih tendinopatija

Tendons are the soft tissue that connects muscles to bones. They are made of collagen and elastin, they are strong and solid, and have no possibility of contraction. Their strength helps us to move. Recovery of tendon injuries is long-lasting and can take more than six months. If a tendon is shed during a time injury, calcification occurs at the site of the injury and the disease is called calcifying tendinopathy. The very existence of calcifications is an indication for treatment with a mechanical shock wave (Shock wave). Mechanical shock waves can act in focus or radially. The difference between focused and radial waves is primarily in their physical basis. Focused shock waves differ from radial shock waves in terms of therapeutic depth of penetration into the tissue. The basic biological effect of a mechanical shock wave is stimulating. The energy of the mechanical shock wave acts at the cellular level by stimulating the reduction of inflammation and pain in the tissue. Using mechanical shock wave in the treatment of calcified tendinopathies, a safe method for breaking calcifications was obtained. Shock wave can be applied to using: different frequency, different number of strokes, as well as different strength of strokes in their studies. The choice of parameters for the application depends on whether it is calcified or non-calcified tendinopathy. Indications for the use are: painful shoulder, heel spur, plantar fasciitis, tennis elbow, Achilles tendon tendinopathy, jumping knee, patellar tendinitis, myalgia, myogelosis and muscular tendon overstrain syndrome. Contraindications for the use are: the existence of prostheses, knees and hips, as well as various orthopedic material, pacemaker, as well as the presence of chronic diseases such as multiple sclerosis, amyotrophic lateral sclerosis or tumors. The application of a mechanical shock wave is new, non-invasive method, easy to apply, always reduces pain and practically without side effects. This method has a special role in the treatment of chronic inflammation of diseased tendons, with or without calcification. The only dilemma in the application of a mechanical shock wave can be in the number of applications as well as the time break between the applications of two consecutive mechanical shock waves therapy.

Effect Of Gastrocnemius Post-exercise Needling Treatment On Achilles Tendon Tendinopathy Prevention

PURPOSE: Long-term post-exercise high intensity gastrocnemius tension can induce the Achilles tendon tendinopathy. The gastrocnemius post-exercise needling treatment can reduce gastrocnemius tension. Therefore, the gastrocnemius post-exercise needling may decrease the risk of Achilles tendon tendinopathy by reduce gastrocnemius tension. METHODS: 32 male 12 weeks old SD rats divided into 4 groups: the needling group (NED group); exercise group (EX group); exercise and needling group (EXNED group) and control group (CON group). The animal treadmill protocol was 60% average VO2max intensity (16.5m/min) eccentric running at -11° condition lasting 90 minutes for 24 days. The EXNED and NED groups accepted needling treatment with 0.25mm diameter needle which penetrate 5mm on gastrocnemius for 5 minutes after exercise each day. Gastrocnemius and Achilles tendon were harvested at the 26th day then measured collagen I/III, MMP-1, mechanical growth factor (TGF-β1, IGF-1) expression and cell apoptosis ratio by western-blot, Immunofluorescence and TUNEL staining. Data was analyzed by SPSS 20.0. RESULTS: The gastrocnemius TGF-β1 in EX group was significantly higher than other three groups (0.20±0.01 VS 0.11±0.01, 0.13±0.02, 0.14±0.01, P<0.05); IGF-1 was no significant difference. In Achilles tendon, TGF-β1 in EX group was significantly higher than other three groups (733.58±306.82 VS 291.92±156.19, 153.74±114.96, 192.67±112.36, OD/μm2, P<0.05); IGF-1 was no significantly difference either. Collagen I in EX and EXNED group were significantly lower than CON and NED group (557.26±210.54, 798.89±122.06 VS 958.59±176.41, 1133.60±251.62, OD/μm2, P<0.05); collagen III in EX group was significantly higher than other three groups (1101.25±196.37 VS 393.03±60.13, 492.25±103.16, 779.32±140.25, OD/μm2, P<0.01), and it was significantly higher in EXNED group than in CON and NED group (779.13±140.42 VS 393.17±60.15, 492.20±103.11, OD/μm2, P<0.05). The MMP-1 in the EX group was significantly higher than other three groups (624.09±176.62 VS 393.51±119.66, 264.9±78.4, 289.4±85.68, OD/μm2, P<0.05). Cell apoptosis ratio was no significant difference. CONCLUSION: The gastrocnemius post-exercise needling treatment can decrease the risk of Achilles tendon tendinopathy by reduce gastrocnemius tension.

Evaluation of the Effectiveness of Orthokine Therapy: Retrospective Analysis of 1000 Cases.

Osteoarthritis is a global health problem. Approaches to symptomatic treatment of its consequences in-clude biological methods, including autologous serum. The aim of the study was to evaluate the effectiveness of Orthokine therapy in our experience. Retrospective analysis of 1000 cases. The results were evaluated on a modified McNab scale (A - excellent, B - good, C - fair, D - poor) two and six months after the end of therapy. The effectiveness of the therapy was estimated as the percentage of satisfactory (A or B) or unsatisfactory (C or D) results. Osteoarthritis of the lumbar spine (n = 400) and knee joint (n = 219) was the most common diagnosis. The highest percentage of patients with a grade A or B result after 6 months was seen with therapy of tennis elbow enthesopathy (88.2%), rotator cuff tendinopathy (72.0%), Achilles tendon tendinopathy (75.0%) and in the early stages of osteoarthritis of the knee (75.9%) and small joints of the hand (77.0%). For cervical and lumbar discopathy, treatment efficacy was at 56.0-62.0% regardless of the size of the hernia. Unsatisfactory results (C and D) predominated in the group of patients with lumbar spinal stenosis (66.1%), wrist osteoarthritis (66.7%), and especially in late-stage hip osteoarthritis (85.3 %). For the largest groups, the frequency of unsatisfactory results was analyzed for selected age ranges. A significant increase in this parameter in subjects over 75 years of age was only seen in patients with severe knee osteoarthritis. 1. Orthokine therapy is highly effective in cases of tendinopathy, enthesopathy, osteoarthritis of the small joints of the hand and in early stages of knee osteoarthritis. 2. Satisfactory results are achieved in the treatment of cervical and lumbar discopathy, while unsatisfactory results prevail in severe degenerative changes in the knee and hip joints and in spinal canal stenosis.

Introduction of a New Index as an Indicator for Achilles Tendon Tendinopathy

Category:SportsIntroduction/Purpose:Achilles tendon tendinopathy is a common problem in our daily practice. The initial therapy consists of conservative treatment and usually leads to a reduction of pain. In some cases though, there is need for surgical treatment. The most common procedure is debridement of the tendon. If there is advanced damage of the tendon, a flexor hallucis longus (FHL) transfer may be indicated. In the current literature, there is a lack of hard criteria about the indications for such a transfer.Methods:We searched our radiologic database from the years 2016 and 2017 for magnetic resonance imaging (MRI) scans of the Achilles tendon. 60 patients were included in a tendinopathy group and 60 patients in a control group with no signs of tendinopathy. Inclusion criteria were severe tendinopathy for the tendinopathy group and a normal Achilles tendon for the control group. Exclusion criteria were other relevant morphologic changes or history of relevant surgery of the lower limb.Axial MRI scans were analyzed on a level of 4-5 centimeters above the ankle joint. The area of triceps surae (TS) and FHL were measured as well as the diameter of TS and an oblique diameter of FHL (from the medial corner of the fibula to the posteromedial corner of the FHL muscle). Then, quotients of the area of the FHL/TS and diameter of the FHL/TS were built and interobserver agreement was analyzed.Results:The quotients for area and for diameter of the FHL/TS showed significantly (p<0.001) higher values in the tendinopathy group. We also found strong to very strong interobserver agreements (rho=0.744). The median value for the quotient of diameter FHL/TS was 2.0 (interquartile range [IQR] 0.8) in the tendinopathy group versus (vs) 1.7 (IQR 0.3) in the control group. The median value for the quotient of area FHL/TS was 1.8 (IQR 1.3) in the tendinopathy group vs 1.3 (IQR 0.7) in the control group.Conclusion:The quotient of the diameter FHL/TS is easy to obtain in our clinical practice. It indicates a relevant FHL hypertrophy, which occurs in advanced Achilles tendon tendinopathy.A value of 2.0 and higher is indicative of symptomatic tendinopathy and may ultimately support the indication for a FHL transfer, which should be the topic of future research.

Exosomes from tendon stem cells promote injury tendon healing through balancing synthesis and degradation of the tendon extracellular matrix.

Tendon injuries are common musculoskeletal system disorders in clinical, but the regeneration ability of tendon is limited. Tendon stem cells (TSCs) have shown promising effect on tissue engineering and been used for the treatment of tendon injury. Exosomes that serve as genetic information carriers have been implicated in many diseases and physiological processes, but effect of exosomes from TSCs on tendon injury repair is unclear. The aim of this study is to make clear that the effect of exosomes from TSCs on tendon injury healing. Exosomes were harvested from conditioned culture media of TSCs by a sequential centrifugation process. Rat Achilles tendon tendinopathy model was established by collagenase‐I injection. This was followed by intra‐Achilles‐tendon injection with TSCs or exosomes. Tendon healing and matrix degradation were evaluated by histology analysis and biomechanical test at the post‐injury 5 weeks. In vitro, TSCs treated with interleukin 1 beta were added by conditioned medium including exosomes or not, or by exosomes or not. Tendon matrix related markers and tenogenesis related markers were measured by immunostaining and western blot. We found that TSCs injection and exosomes injection significantly decreased matrix metalloproteinases (MMP)‐3 expression, increased expression of tissue inhibitor of metalloproteinase‐3 (TIMP‐3) and Col‐1a1, and increased biomechanical properties of the ultimate stress and maximum loading. In vitro, conditioned medium with exosomes and exosomes also significantly decreased MMP‐3, and increased expression of tenomodulin, Col‐1a1 and TIMP‐3. Exosomes from TSCs could be an ideal therapeutic strategy in tendon injury healing for its balancing tendon extracellular matrix and promoting the tenogenesis of TSCs.

Subtle cavus foot

Objective: To identify the prevalence of ankle and foot disorders in patients with subtle cavus foot (SCF). Methods: This was a retrospective case series. Patients with lower limb disorders who upon clinical examination were also diagnosed with SCF were evaluated. Patients diagnosed with disorders that could lead to this deformity, such as trauma sequelae and neurological disorders, and those with the presence of cavovarus foot with severe deformity were excluded. Correlations between ankle and foot disorders and the presence of SCF were evaluated. Results: A total of 119 patients (67 males/52 females) were evaluated, totalling 238 feet. One hundred forty-one feet had subtle cavus, and 97 feet had physiological alignment. Of the 141 SCF, 76 feet were right feet, and 65 were left feet. Twenty-two patients had bilateral SCF. One undred forty complaints were identified, which led to 18 diagnoses: ankle instability (37 cases/26.2%), peroneal tendon tendinopathy (31 cases/22.0%), plantar fasciitis (18 cases/12.8%), Achilles tendon tendinopathy (10 cases/7.1%), osteochondral talar lesion (7 cases/5.0%), mechanical metatarsalgia (6 cases/4.3%), hallux sesamoid disorders (5 cases/3.5%), Morton’s neuroma (5 cases/3.5%), hallux valgus (5 cases/3.5%), pain in the lateral side of the foot (4 cases/2.8%), anterior impact (3 cases/2.1%), pain in the medial side of the tibia (2 cases/1.4%), plantar plate injury (2 cases/1.4%) and other disorders with a prevalence &lt;1%. Conclusion: We found a clear correlation between SCF and acute and chronic ankle instability, peroneal and Achilles tendon tendinopathy and plantar fasciitis. &#x0D; Level of Evidence IV; Therapeutic Studies; Case Series.

PRP improves short term clinical results in tendinopathy of Achilles tendon

BackgroundChronic Achilles tendinopathy is a common pathology and standardized treatment strategies are lacking. The purpose of this study is to evaluate the efficacy of Platelet Rich Plasma (PRP) injections in treatment of Achilles tendinopathy. Materials and MethodsTwenty tendons in seventeen patients were included. Mean age of participants was 52.6 years (range, 34-72 years). All patients were treated by one single PRP injection. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score and pain level according to Visual Analogue Scale (VAS) were noted in all patients pre-treatment and at 2 weeks, 2 and 6 months post-treatment. ResultsThe average AOFAS Hindfoot Score increased from 37.95 points (range, 33 to 52 points) pre-treatment to 90.8 (range, 83 to 97 points) post-treatment at 6 months. The average pain level according to VAS decreased from 8.65 points pre-treatment to 1.15 points post-treatment at 6 month. All patients returned to daily activities after 2 weeks and to sports activities after 1 month. Two of the patients were able to practice sports after the 3 month post PRP injection due to pain. None of the patients showed complications or adverse effects after the PRP injection. ConclusionLocal PRP injections showed effective results in chronic Achilles tendinopathy without any complications and seems to be a good treatment alternative in this entity. Moreover it might have the ability to avoid surgical intervention. Level of EvidenceIV.

The pathogenesis of Achilles tendinopathy: a systematic review.

Achilles tendinopathy is a degenerative, not an inflammatory, condition. It is prevalent in athletes involved in running sports. A systematic literature review on Achilles tendon tendinopathy has been performed according to the intrinsic (age, sex, body weight, tendon temperature, systemic diseases, muscle strength, flexibility, previous injuries and anatomical variants, genetic predisposition and blood supply) and extrinsic risk factors (drugs and overuse), which can cause tendon suffering and degeneration. Different theories have been found: Neurogenic, Angiogenic, Impingement and "Iceberg" Hypotheses. Multiple databases were utilized for articles published between 1964 and 2013. The different hypothesis were analyzed, differently considering those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis. Various risk factors have been identified and have shown an interaction between them such as genes, age, circulating and local cytokine production, sex, biomechanics and body composition.

Achilles tendon pathology, present and future

Lecture 18IntroductionThe recent progress in molecular biology, could make possible to identify the factors which influence the metabolism of the tenocytes and promote their natural healing process. The role of...