Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon.

OBJECTIVE: To ascertain whether tendon samples harvested from patients with calcific insertional Achilles tendinopathy showed features of failed healing response, and whether abnormal quantities of type II collagen had been produced in that area by these tenocytes. DESIGN: Comparative laboratory study. DESIGN: University teaching hospitals. PATIENTS: Tendon samples were harvested from eight otherwise healthy male individuals (average age 47.5+/-8.4 years, range 38 to 60) who were operated for calcific insertional Achilles tendinopathy and from nine male patients who died of cardiovascular events (mean age 63.1+/-10.9 years) while in hospital. INTERVENTIONS: Open surgery for calcific insertional Achilles tendinopathy. MAIN OUTCOME MEASURE: Semi-quantitative histochemical, immunohistochemical, and immunocytochemical methods to ascertain whether tendinopathic tendons were morphologically different from control tendons, and whether abnormal types of collagen were produced. RESULTS: Tenocytes from tendons from patients with calcific insertional Achilles tendinopathy exhibit chondral metaplasia, and produce abnormally high quantities of collagen type II and III. CONCLUSIONS: The altered production of collagen may be one reason for the histopathological alterations described in the present study. Areas of calcific insertional Achilles tendinopathy have been subjected to abnormal loads. These tendons may be less resistant to tensile forces. Further studies should investigate why some tendons undergo these changes.     

Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes

BACKGROUND: Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. PURPOSE: To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant). RESULTS: Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. CONCLUSION: Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.     

Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients.

OBJECTIVE: To report the outcome of surgery for chronic recalcitrant Achilles tendinopathy in nonathletic and athletic subjects. DESIGN: Case-control study. SETTING: University teaching hospitals. PATIENTS: We matched each of the 61 nonathletic patients with a diagnosis of tendinopathy of the Achilles tendon with an athletic patient with tendinopathy of the main body of the Achilles tendon of the same sex and age (+/-2 years). A match was possible for 56 patients (23 males and 33 females). Forty-eight nonathletic subjects and 45 athletic subjects agreed to participate. INTERVENTIONS: Open surgery for Achilles tendinopathy. MAIN OUTCOME MEASURE: Outcome of surgery, return to sport, complication rate. RESULTS: Nonathletic patients were shorter and heavier than athletic patients. They had greater body mass index, calf circumference, side-to-side calf circumference differences, and subcutaneous body fat than athletic patients. Of the 48 nonathletic patients, 9 underwent further surgery during the study period, and only 25 reported an excellent or good result. Of the 45 athletic subjects, 4 underwent further surgery during the study period, and 36 reported an excellent or good result. The remaining patients could not return to their normal levels of activity. In all of them, pain significantly interfered with daily activities. CONCLUSIONS: Nonathletic subjects experience more prolonged recovery, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.     

Leg stiffness changes in athletes with Achilles tendinopathy

Overuse injuries of the Achilles tendon cause impairment in lower leg muscle-tendon function. The purpose of this study was to evaluate leg stiffness in patients suffering unilateral Achilles tendinopathy. 51 athletes with unilateral Achilles tendinopathy underwent leg stiffness testing by modeling the vertical ground reaction force in a contact mat, measuring flight and contact time during hopping. Clinical status was estimated with a pain VAS and a validated questionnaire (VISA-A). The 'leg stiffness ratio' (LSR=stiffness of injured leg/stiffness of healthy leg) was calculated to determine the relative patient affectation and for intra-group comparison. 84 percent of subjects showed lower leg stiffness in the affected side during hopping. Leg stiffness was significantly lower in the limb affected by Achilles tendinopathy than in the healthy side (14.07±3.74 kN/m vs. 15.61±4.01 kN/m, p=0.047); overall LSR was 0.90±0.09. Intra-group comparison did not show significant differences related to patients' age, gender, sport level, and site of tendon injury (midportion or insertional). Leg stiffness was significantly reduced in patients with unilateral Achilles tendinopathy probably related to increasing ankle compliance. Regular leg stiffness assessment would be beneficial for athletes suffering Achilles tendon problems in terms of quantifying performance capabilities and providing objective data for a safer return to sport activity.     

Standardized pain mapping for diagnosing Achilles tendinopathy

ObjectivesTo assess the level of agreement between patient-reported pain using a standardized pain map and the physician-determined clinical diagnosis of Achilles tendinopathy.DesignCross-sectional study.MethodsEligible patients were adults visiting a sports physician for symptoms in the Achilles tendon region. Patients completed a digital questionnaire and indicated one location on a pain map where they experienced their pain. The primary outcome measure was level of agreement (% and Kappa coefficient) between patient-reported pain on the pain map and the physician-determined clinical diagnosis (defined as localized pain associated with tendon-loading activities and pain on palpation with or without tendon thickening). The secondary outcome measure was the agreement between the location on the pain map (midportion/insertional region) with the clinical diagnosis of midportion/insertional Achilles tendinopathy.Results110 patients (mean (SD) age 48 (13), 61% men) with pain in the Achilles region were included. In 102 (93%, Kappa = 0.86, CI 0.78–0.95) patients who indicated pain in the Achilles tendon region on the pain map, the clinical diagnosis of Achilles tendinopathy was made by the sports physician. 82% of the patients had the clinical diagnosis of tendinopathy in the specific region of the tendon they marked on the pain map (Kappa = 0.67, CI 0.54–0.79).ConclusionsThere is almost perfect agreement between patient-reported pain on a pain map and a physician-established clinical diagnosis of Achilles tendinopathy. There was substantial agreement between the localization of the pain that was selected by the patient and the diagnosis of insertional/midportion Achilles tendinopathy by the physician. This tool could potentially aid in adequate triage for specialized care and for researchers performing large epidemiological studies.     

Surgical treatment of Achilles tendinitis by decompression of the retrocalcaneal bursa and the superior calcaneal tuberosity

BACKGROUND: Initial nonoperative treatment of pain at the Achilles tendon, often referred to as "tendinitis," is not always successful. HYPOTHESIS: Surgical treatment is effective for patients with insertional tendinitis unrelieved by nonoperative measures. STUDY DESIGN: Retrospective cohort study. METHODS: Thirty-five patients (41 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. The technique consisted of a single incision along the lateral border of the Achilles tendon. The dissection exposed the retrocalcaneal bursa and fat pad, which were completely excised along with any scarred and thickened paratenon. A partial calcaneal exostectomy of the tubercle was performed. RESULTS: At a minimum follow-up of 20 months (average, 39), the patients' pain scores (rated from 0 to 6) improved from 4.7 (SD, 1.1) preoperatively to 1.5 (SD, 1.3); 90% had complete or significant relief of symptoms, 10% felt improved, and none felt unchanged or worse. CONCLUSIONS: Surgical treatment of chronic Achilles tendon pain with resection of the prominent tuberosity, complete debridement of the bursa, excision of thickened, scarred paratenon, and removal of accessible calcific deposits within the tendon is an effective treatment.     

Endoscopic Achilles tenodesis: a surgical alternative for chronic insertional tendinopathy

This report describes an endoscopic approach for visualization and repair of heel structures potentially involved in patients presenting chronic calcaneal tendon insertion pain. Tendon–bone junction separation allows enthesis debridement. Tenodesis with a knotless absorbable anchor completes this minimally invasive surgical procedure for chronic insertional Achilles tendinopathy.     

Magnetic resonance signal, rather than tendon volume, correlates to pain and functional impairment in chronic Achilles tendinopathy

PURPOSE: To depict abnormal tendon matrix composition using magnetic resonance imaging (MRI) in chronic Achilles tendinopathy, and correlate intratendinous signal alterations to pain and functional impairment. MATERIAL AND METHODS: MRI of the Achilles tendon was performed on 25 patients with chronic Achilles tendinopathy (median age 50, range 37-71 years). All patients suffered from pain in the mid-portion of the Achilles tendon. Intratendinous signal was calculated from five different sagittal sequences, using a computerized 3D seed-growing technique. Pain and functional impairment were evaluated using a questionnaire completed by patients. RESULTS: Severity of pain and functional impairment correlated to increased mean intratendinous signal in the painful tendon in all MR sequences (P < 0.05, median r = 0.38, range 0.28-0.43 for pain; P < 0.05, median r = 0.48, range 0.29-0.49 for functional impairment). However, tendon volume did not correlate to pain or functional impairment (P > 0.05). Difference in mean intratendinous signal between symptomatic and contralateral asymptomatic tendons was highly significant in all sequences (P < 0.05) except on T2-weighted images (P = 0.6). CONCLUSION: Severity of pain and disability correlated to increased MR signal rather than to tendon volume in patients with unilateral mid-portion chronic Achilles tendinopathy.     

Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy

Thirty-eight athletes with unilateral patellar tendinopathy (17 with a tendinopathy of the main body of the tendon, and 21 with an insertional tendinopathy) underwent ultrasound-guided multiple percutaneous longitudinal tenotomy under local anaesthetic infiltration after failure of conservative management. Thirty-four patients were reviewed at least 24 months after the operation. Sixteen patients were rated excellent, nine good, eight fair, and five poor. Nine of the 13 patients with a fair or poor result had an insertional tendinopathy, and eight of them underwent a formal exploration of the patellar tendon. Before the operation, there were some areas of altered echogenicity at and around the site of involvement. These were still visible 6 wk after surgery in 70% of the patients. At the latest follow-up, in the patients with an excellent or good result, the tendon was generally isoechogenic but slightly thicker (P = 0.06) than the normal contralateral. In the patients with a fair or poor result, the tendon was significantly thicker than the contralateral (P = 0.03), and showed some areas of mixed echogenicity. In the patients in whom the procedure was successful, the thicker operated tendon did not interfere with physical training. Bilateral isokinetic peak torque (Nm), average work (Joules), and average power (Watts) were tested at 90 degrees x s(-1). Immediately before the operation, there was no significant difference in peak torque, but total work and average power were significantly lower in the limb to be operated (0.01 < P < 0.05). By the end of the study, although peak torque was, on average, within 7% of the unoperated limb, total work and average power were still significantly lower than in the unoperated limb (0.01 < P < 0.04). Percutaneous longitudinal internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. In our hands, it has become the first line operative intervention in the treatment of chronic patellar tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from an tendinopathy at the attachment of the patellar tendon at the lower pole of the patella, a formal surgical exploration with stripping of the paratenon is preferable.     

Magnetic resonance imaging in chronic Achilles tendinopathy.

The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium-enhanced T1-WI images (CME T1-WI), and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic, painful Achilles tendinosis, before and 2 years after surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in eight, good in five, fair in one and poor in one patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated with the histopathologic findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72s) was seen in DEMRI in the symptomatic Achilles tendons, with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei, and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed-growing MRI technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter- and intra-observer reliability. The technique was also used to follow up prospectively the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of 1 year, we evaluated the biological effect of tendon repair following iatrogenic tendon injury by five transversal ultrasound-guided core biopsies employing a needle technique in chronic Achilles tendinopathy. Alterations found during healing, such as tendon volume and intratendinous reactive changes, could be monitored by MR imaging, and subsided as noted in the 7- and 12-month follow-ups. In study V, we evaluated the effect of treatment with a 3-month, daily performed, heavy-loaded calf-muscle strength training program in 25 patients who had been suffering from chronic, painful Achilles tendinopathy. Tendon volume decreased by 14%, and the mean intratendinous signal by 23%. The clinical outcome was improved. In study VI, we revealed tendon adaptation immediately following calf-muscle strength training. An MRI examination within 30min of the performed exercises resulted in increased total tendon volume (12%) and mean intratendinous signal (31%). CONCLUSION: MRI techniques can be used as an adjunct to clinical evaluation by monitoring morphological effects following different treatment interventions, thereby adding evidence in clinical studies on patients with chronic Achilles tendinopathy.     

Imaging in the assessment and management of Achilles tendinopathy and paratendinitis

Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tendon degeneration is often accompanied by paratendinitis. Radiologists are frequently asked to use imaging techniques to evaluate patients with problems at or around the Achilles tendon. The main imaging modalities used in the assessment of Achilles tendon disorders are plain radiography, ultrasound, and magnetic resonance imaging. In recent years, ultrasound has also been used to guide minimally invasive local treatments for Achilles tendinopathy, which may prevent the need for surgery if conservative treatments have failed. In this article, we review the imaging features of Achilles tendinopathy and consider the relative strengths and weaknesses of the various imaging techniques. The role of imaging in directing patient management is also discussed, with particular focus on ultrasound-guided treatments.     

Evaluation of sonoelastography in Achilles tendon of healthy volunteers and patients with symptomatic Achilles tendon

Aim and objectives: To assess the role of SEL in evaluation of Achilles tendon. Methodology: This study included 40 healthy volunteers and 40 patients with symptomatic Achilles tendon. All patients were examined by conventional B-mode ultrasound, sonoelastography and MRI. Results: Achilles tendons of the volunteers were characterized by hard texture with higher strain ratios than those of the patients with Achilles tendinopathy. No significant differences could be detected between SR of male and female volunteers yet significant differences could be detected in the volunteer group above and below forty being lower with softer tendon properties in the group above forty with a cut-off value of ≤1.84 between healthy and diseased group. Sonoelastography had the sensitivity of 89.1% and specificity of 96.1% for diagnosis of tendinopathy with results superior to those of conventional B-mode ultrasonography. Conclusion: SEL is a reliable tool in the evaluation of Achilles tendinopathy with sensitivity and specificity superior to B-mode US. Strain ratio provides excellent non-invasive diagnostic data adds strongly in more objective evaluation of Achilles tendon properties.     

High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy

BACKGROUND: Results of high-energy extracorporeal shock wave therapy for the treatment of insertional Achilles tendinopathy are not determined. It is unclear how local anesthesia alters the outcome of this procedure. HYPOTHESIS: Extracorporeal shock wave therapy is an effective treatment for insertional Achilles tendinopathy. Local anesthesia field block adversely affects outcome. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Thirty-five patients with chronic insertional Achilles tendinopathy were treated with 1 dose of high-energy extracorporeal shock wave therapy (ESWT group; 3000 shocks; 0.21 mJ/mm2; total energy flux density, 604 mJ/mm2), and 33 were treated with nonoperative therapy (control group). All extracorporeal shock wave therapy procedures were performed using a local anesthesia field block (LA subgroup, 12 patients) or a nonlocal anesthesia (NLA subgroup, 23 patients). Evaluation was by visual analog score and by Roles and Maudsley score. RESULTS: One month, 3 months, and 12 months after treatment, the mean visual analog score for the control and ESWT groups were 8.2 and 4.2 (P < .001), 7.2 and 2.9 (P < .001), and 7.0 and 2.8 (P < .001), respectively. Twelve months after treatment, the number of patients with successful Roles and Maudsley scores was statistically greater in the ESWT group compared with the control group (P > .0002), with 83% of ESWT group patients having a successful result, and the mean improvement in visual analog score for the LA subgroup was significantly less than that in the NLA subgroup (F = 16.77 vs F = 53.95, P < .001). The percentage of patients with successful Roles and Maudsley scores did not differ among the LA and NLA subgroups. CONCLUSION: Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Local field block anesthesia may decrease the effectiveness of this procedure.     

Strain behavior of the distal achilles tendon: implications for insertional achilles tendinopathy

BACKGROUND: The changes associated with Achilles insertional tendinopathy (AIT) are seen in the anterior portion of the Achilles tendon near its calcaneal insertion. Strain behavior of this portion of the tendon was evaluated. HYPOTHESIS: The highest strains are in the anterior portion of the tendon. STUDY DESIGN: Controlled laboratory study. METHODS: Six cadaveric legs were tested. While moving through a functional range of ankle motion, strains in five different regions of the tendon insertion were tested. First, the load on the tendon was increased from 30 to 170 N in the starting, plantar flexed position. Then, the ankle was moved from a plantar flexed position into dorsiflexion. RESULTS: Strains in the posterior sites increased significantly (P < 0.001) as the movement into dorsiflexion occurred. This was significantly (P < 0.01) different than the anterior sites, which showed a trend toward decreasing strain. CONCLUSIONS: Although the anterior portion of the Achilles tendon is generally affected in AIT, relative strain shielding is seen in this portion of the tendon. These findings suggest that the role of repetitive tensile loads in the causation of AIT is more complex than often described. Clinical Relevance: These findings may explain the variable therapeutic response following measures aimed at decreasing tensile loads on the tendon.     

Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study

Objectiveto examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function.Designcross-sectional study. Setting: online survey platform.Participants119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy.Main outcome measuresA range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders.ResultsPsychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction.ConclusionThe current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.     

Achilles tendinopathy after treatment with fluoroquinolone

Fluoroquinolone antibiotic therapy is a recognized but poorly understood cause for Achilles tendinopathy. We report here a patient who developed bilateral partial Achilles tendon tears as a result of fluoroquinolone therapy. Ultrasound and MRI were both useful in identifying and distinguishing between Achilles tendinosis and tendon rupture. The current published literature on this problem was also reviewed.     

Noninsertional Achilles tendinopathy: Pathology and management

Many patients present to their physician's office with the chief complaint of pain at the Achilles tendon. This review discusses the pathology, diagnosis, and treatment of Achilles tendinopathy. Achilles tendinopathy is generally caused by chronic stress to the tendon, leading to a defective arrangement of collagen fibers in the Achilles tendon. This then results in pain and limited function. Ultrasound imaging can help identify the abnormal portion of the tendon. Various treatments are available for Achilles tendinopathy, the most current of which are discussed in this article. Appropriate treatment can potentially lead to a full recovery.     

Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy.

OBJECTIVE: Achilles tendinopathy is prevalent in athletes, but can also affect sedentary patients. We studied the effects of eccentric exercises in sedentary non-athletic patients with Achilles tendinopathy. METHODS: Thirty-four sedentary patients (18 males, average age 44 years, range 23-67; 16 females, average age 51 years, range 20-76; average BMI: 28.6+/-4.7, range 22.1-35.4) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance (39+/-S.D. 22.8) and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks. RESULTS: Fifteen patients (44%) did not improve with eccentric exercise regimen. Three patients improved after perintendinous injections aprotinin and local anaesthetic. Surgery was performed in seven patients as 6 months of conservative management failed to produce improvements. The overall average VISA-A scores at latest follow up was 50 (S.D. 26.5). CONCLUSIONS: Eccentric exercises, though effective in nearly 60% of our patients, may not benefit sedentary patients to the same extent reported in athletes.     

Treatment for insertional Achilles tendinopathy: a systematic review

Purpose

Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy.

Methods

A structured systematic review of the literature was performed to identify surgical and non-surgical therapeutic studies reporting on ten or more adults with insertional Achilles tendinopathy. MEDLINE, CINAHL, EMBASE (Classic) and the Cochrane database of controlled trials (1945–March 2011) were searched. The Coleman methodology score was used to assess the quality of included articles, and these were analysed with an emphasis on change in pain score, patient satisfaction and complication rate.

Results

Of 451 reviewed abstracts, 14 trials met our inclusion criteria evaluating 452 procedures in 433 patients. Five surgical techniques were evaluated; all had a good patient satisfaction (avg. 89 %). The complication ratio differed substantially between techniques. Two studies analysed injections showing significant decrease in visual analogue scale (VAS). Eccentric exercises showed a significant decrease in VAS, but a large group of patients was unsatisfied. Extracorporeal shockwave therapy (ESWT) was superior to both wait-and-see and an eccentric training regime. One study evaluated laser CO², TECAR and cryoultrasound, all with significant decrease in VAS.

Conclusions

Despite differences in outcome and complication ratio, the patient satisfaction is high in all surgical studies. It is not possible to draw conclusions regarding the best surgical treatment for insertional Achilles tendinopathy. ESWT seems effective in patients with non-calcified insertional Achilles tendinopathy. Although both eccentric exercises resulted in a decrease in VAS score, full range of motion eccentric exercises shows a low patient satisfaction compared to floor level exercises and other conservative treatment modalities.

Level of evidence

III.     

跟腱Haglund病的手术治疗

目的:研究跟腱Haglund病的手术治疗效果。方法:21例跟腱Haglund病患者保守治疗无效后采用切开或关节镜手术治疗。术前测量Fowler-Phillip角和斜平行线,术前术后分别进行VAS评分、Tegner评分和VISA-A评分。结果:术后平均随访(47.5±16.7)个月(23-72个月),与术前相比,VAS评分显著降低,Tegner评分和VISA-A评分显著提高,优良率95.2%。结论:跟腱Haglund病手术治疗可获得良好的临床效果,但需根据跟腱的病变情况确定采取关节镜或切开手术。