scholarly journals Achilles Tendon Structure Differs Between Runners And Non-Runners Despite No Clinical Signs Or Symptoms Of Mid-Substance Tendinopathy

2018 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kenton L. Hagan ◽  
Ellen Casey ◽  
Josh R. Baxter
Keyword(s):  
Young Adults ◽  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Achilles Tendinopathy ◽  
Ultrasound Images ◽  
Distance Running ◽  
Distance Runners ◽  
Structural Differences ◽  
The Right

AbstractAchilles tendinopathy affects many running athletes and often leads to chronic pain and functional deficits. While changes in tendon structure have been linked with tendinopathy, the effects of distance running on tendon structure is not well understood. Therefore, the purpose of this study was to characterize structural differences in the Achilles tendons in healthy young adults and competitive distance runners using quantitative ultrasound analyses. We hypothesized that competitive distance runners with no clinical signs or symptoms of tendinopathy would have quantitative signs of tendon damage, characterized by decreased collagen alignment and echogenicity, in addition to previous reports of thicker tendons. Longitudinal ultrasound images of the right Achilles tendon mid-substance were acquired in competitive distance runners and recreationally-active adults. Collagen organization, mean echogenicity, and tendon thickness were quantified using image processing techniques. Clinical assessments confirmed that runners had no signs or symptoms of tendinopathy and controls were only included if they had no history of Achilles tendon pain or injuries. Runner tendons were 40% less organized, 48% thicker, and 41% less echogenic compared to the control tendons (p < 0.001). Young adults engaged in competitive distance-running have structurally different tendons than recreationally-active young adults. While these structural differences have been associated with tendon damage, the lack of clinical symptoms of tendinopathy may suggest that these detected differences may either be precursors of tendinopathy development or protective adaptations to cyclic tendon loading experienced during running.

scholarly journals Achilles tendon structure differs between competitive distance runners and nonrunners despite no clinical signs or symptoms of midsubstance tendinopathy

2018 ◽  
Vol 125 (2) ◽  
pp. 453-458 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kenton L. Hagan ◽  
Ellen Casey ◽  
Josh R. Baxter
Keyword(s):  
Young Adults ◽  
Achilles Tendon ◽  
Structural Changes ◽  
Clinical Signs ◽  
Tendon Injury ◽  
Control Group ◽  
Protective Mechanism ◽  
Ultrasound Images ◽  
Distance Running ◽  
Distance Runners

Achilles tendinopathy affects many running athletes and often leads to chronic pain and functional deficits. Although changes in tendon structure have been linked with tendinopathy, the effects of distance running on tendon structure are not well understood. Therefore, the purpose of this study was to characterize structural differences in the Achilles tendons in healthy young adults and competitive distance runners using quantitative ultrasound analyses. We hypothesized that competitive distance runners with no clinical signs or symptoms of tendinopathy would have quantitative signs of tendon damage, characterized by decreased collagen alignment and echogenicity, in addition to previous reports of thicker tendons. Longitudinal ultrasound images of the right Achilles tendon midsubstance were acquired in competitive distance runners and recreationally active adults. Collagen organization, mean echogenicity, and tendon thickness were quantified using image processing techniques. Clinical assessments confirmed that runners had no signs or symptoms of tendinopathy, and controls were only included if they had no history of Achilles tendon pain or injuries. Runner tendons were 40% less organized, 48% thicker, and 41% less echogenic compared with the control tendons ( P < 0.001). Young adults engaged in competitive distance running have structurally different tendons than recreationally active young adults. NEW & NOTEWORTHY In this study, we quantified the Achilles tendon substructure in distance runners, and a control group of young adults, to determine whether distance running elicits structural adaptations of the tendon. We found that competitive distance runners have structurally compromised Achilles tendons despite not showing any clinical signs or symptoms of tendon injury. These findings suggest that distance running may stimulate structural changes as a protective mechanism against tendon pain and dysfunction.

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

scholarly journals Characterization of a Novel Model of Overuse-Induced Calcific Achilles Tendinopathy in Mice: Contralateral Tendinopathy Following Unilateral Tenotomy

2017 ◽  
Author(s):  
Liang Wang ◽  
Jie Zhang ◽  
Gang-hui Yin ◽  
Zhong-min Zhang ◽  
Tian-yu Chen ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Underlying Mechanism ◽  
Biomechanical Properties ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Human Beings ◽  
Achilles Tenotomy ◽  
The Right ◽  
Experimental Group

AbstractObjectiveTo develop a simple but reproducible overuse induced animal model of Achilles tendinopathy in mice for better understanding the underlying mechanism and prevention of calcific Achilles tendinopathy.Methods80 C57/B6 mice (8-9 weeks old) were employed and randomly divided into control group and experimental group. Unilateral Achilles tenotomy was performed on the right hindlimb of experiment group. After 12 weeks, the onset of Achilles tedinopathy in the contralateral Achilles tendon was determined by radiological assessment, histological analysis, electron microscopy observation and biomechanical test.ResultsThe onset of calcific Achilles tendinopathy in contralateral Achilles tendon was confirmed after 12 weeks unilateral tenotomy. The contralateral Achilles tendon of experimental group was characterized as hypercelluarity, neovascularization and fused collagen fiber disarrangement, compared to the control group. Importantly, intratendon endochondral ossification and calcaneus deformity was featured in contralateral Achilles tendon. Additionally, poor biomechanical properties in the contralateral Achilles tendon revealed the incidence of Achilles tedinopathy.ConclusionWe hereby introduce a novel simple but reproducible spontaneous contralateral calcific Achilles tendinopathy model in mice, which represents the overuse conditions during the tendinopathy development in human-beings. It should be a useful tool to further study the underlying pathogenesis of calcific Achilles tendinopathy.

scholarly journals Augmentation of ruptured tendon using fresh frozen Achilles tendon allograft in two dogs: a case report

2013 ◽  
Vol 58 (No. 1) ◽  
pp. 50-55
Author(s):  
MR Alam ◽  
WJ Gordon ◽  
SY Heo ◽  
KC Lee ◽  
NS Kim ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Weight Bearing ◽  
Clinical Signs ◽  
Tibial Tuberosity ◽  
Tendon Allograft ◽  
Fresh Frozen ◽  
The Right ◽  
Suture Failure ◽  
Achilles Tendon Allograft

This article describes two cases of augmentation of ruptured tendon with fresh frozen Achilles tendon allograft (FFATA) in dogs. Case 1 was a two-year-old crossbreed dog (29 kg) that presented with an open wound on the right forelimb and with complete rupture of the flexor carpi ulnaris and superficial digital flexor tendons. Case 2 was a four-year-old crossbreed dog (4 kg) with partial ruptures of the patellar tendon and detachment of the tibial tuberosity in the right hind limb. In both cases, the ends of the ruptured tendon were sutured and apposed after debridement. To minimize suture failure, FFATA (cut to sufficient size) was placed across the primary suture with tension and sutured to the host tendon. In addition, Case 2 received a Krackow suture through a transverse bone tunnel made in the tibia to fix the patellar tendon along with the tibial tuberosity in situ. The surgical areas healed without any evidence of exaggerated inflammatory response or clinical signs consistent with rejection of the allograft. Both the dogs had normal ambulation and weight bearing on the affected limb 12 weeks postoperatively. No postoperative complications were observed during a one-year follow up period except for slight contracture of the carpus and digits of the affected limb in Case 1. Thus, ruptured tendons can be successfully repaired using suture and augmentation with FFCTA. Augmentation with FFATA may provide additional stability, which counters tension on the primary repair and reduces the chance of gap formation or suture failure in case of reconstruction of the damaged tendon in dogs. &nbsp;

The Effects of Orthotic Heel Lifts on Achilles Tendon Force and Strain During Running

2012 ◽  
Vol 28 (5) ◽  
pp. 511-519 ◽  
Author(s):  
Dominic James Farris ◽  
Erica Buckeridge ◽  
Grant Trewartha ◽  
Miranda Polly McGuigan
Keyword(s):  
Achilles Tendon ◽  
Lower Limb ◽  
Inverse Dynamics ◽  
Force Plate ◽  
Medial Gastrocnemius ◽  
Ultrasound Images ◽  
Moment Arm ◽  
Flexion Extension ◽  
Tendon Force ◽  
The Right

This study assessed the effects of orthotic heel lifts on Achilles tendon (AT) force and strain during running. Ten females ran barefoot over a force plate in three conditions: no heel lifts (NHL), with 12 mm heel lifts (12HL) and with 18 mm heel lifts (18HL). Kinematics for the right lower limb were collected (200 Hz). AT force was calculated from inverse dynamics. AT strain was determined from kinematics and ultrasound images of medial gastrocnemius (50 Hz). Peak AT strain was less for 18HL (5.5 ± 4.4%) than for NHL (7.4 ± 4.2%) (p = .029, effect size [ES] = 0.44) but not for 12HL (5.8 ± 4.8%) versus NHL (ES = 0.35). Peak AT force was significantly (p = .024, ES = 0.42) less for 18HL (2382 ± 717 N) than for NHL (2710 ± 830 N) but not for 12HL (2538 ± 823 N, ES = 0.21). The 18HL reduced ankle dorsiflexion but not flexion-extension ankle moments and increased the AT moment arm compared with NHL. Thus, 18HL reduced force and strain on the AT during running via a reduction in dorsiflexion, which lengthened the AT moment arm. Therefore, heel lifts could be used to reduce AT loading and strain during the rehabilitation of AT injuries.

Gouty Achilles Tendinopathy: A Case Report

2019 ◽  
Vol 109 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Chandana Halaharvi ◽  
Eric So ◽  
Cherreen Tawancy ◽  
Kurt A. Kibler ◽  
Daniel Logan
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Fluid Collection ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Incision And Drainage ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
The Right ◽  
The Relationship

Tendinopathy in the presence of gouty arthropathy is relatively common, yet the clinical suspicion for gout involvement in acute tendon pain remains low. A 49-year-old man presented with an acute, tender, erythematous mass to the right posterior heel. A computed tomographic scan was obtained, which revealed a septated fluid collection superficial to the Achilles tendon. The patient was taken to the operating room for an incision and drainage with debridement, and the abscess was found to be filled with caseous material. The diagnosis of gout was confirmed with pathology. The calcaneus was submitted to biopsy, and the results were negative for osteomyelitis. The patient was returned to the operating room for repair of the Achilles tendon with flexor hallucis longus tendon transfer. Postoperatively, the patient was nonweightbearing for 6 weeks. Oral colchicine was used perioperatively, and a steroid taper was administered. The patient was started on allopurinol and colchicine for chronic treatment. At 14 months, the patient was walking without pain or recurrence of the mass. Although the relationship between hyperuricemia and tendinopathy is not completely understood, it is apparent that tendon involvement may be a sequela in patients with gout. When a patient presents with acute tendon pain, gout should be considered in the differential diagnosis.

scholarly journals Tendon structure quantified using ultrasound imaging differs based on location and training type

2018 ◽  
Vol 125 (6) ◽  
pp. 1743-1748 ◽  
Author(s):  
Kenton L. Hagan ◽  
Todd Hullfish ◽  
Ellen Casey ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Ultrasound Imaging ◽  
Ultrasound Images ◽  
Distance Runners ◽  
Specific Loading ◽  
Cross Country ◽  
Collagen Alignment ◽  
Tendon Remodeling ◽  
Tendon Collagen

Achilles tendinopathy is 10 times more common among running athletes compared with age-matched peers. Load-induced tendon remodeling and its progression in an at-risk population of developing symptomatic tendinopathy are not well understood. The purpose of this study was to prospectively characterize Achilles and patellar tendon structure in competitive collegiate distance runners over different competitive seasons using quantitative ultrasound imaging. Twenty-two collegiate cross-country runners and eleven controls were examined for this study. Ultrasound images of bilateral Achilles and patellar tendons were obtained near the start and end of the collegiate cross-country season and the conclusion outdoor track season. Collagen organization, mean echogenicity, tendon thickness, and neovascularity were determined using well-established image processing techniques. Achilles tendon collagen was less aligned in runners compared with controls (28% greater) but improved slightly (7% decrease) after the completion of the track season. Conversely, patellar tendons in runners were similar to control tendons throughout the cross-country season but underwent collagen alignment (17% decrease) and tendon hypertrophy (21% increase). Our findings indicate that Achilles tendon structure in trained runners differs structurally from control tendons but is stable throughout training while patellar tendon structure changes in response to the transition in training volume between cross-country and track seasons. These findings expand upon prior reports that some degree of tendon remodeling may act as a protective adaptation for sport specific loading. NEW & NOTEWORTHY In this study we prospectively examined the Achilles and patellar tendon structure of distance runners to determine if continued training through multiple seasons elicits tendon remodeling or pathology. We found that Achilles and patellar tendons respond uniquely to the changing loads required during each season. Achilles tendon collagen alignment is mostly stable throughout the competitive cycle, but the patellar tendon structurally remodels following the transition from cross-country to track season.

scholarly journals Tendon Structure Quantified using Ultrasound Imaging Differs Based on Location and Training Type

2018 ◽  
Author(s):  
Kenton L. Hagan ◽  
Todd Hullfish ◽  
Ellen Casey ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Ultrasound Imaging ◽  
Structural Changes ◽  
Ultrasound Images ◽  
Distance Runners ◽  
Cross Sectional ◽  
Specific Loading ◽  
Cross Country ◽  
Tendon Remodeling

AbstractAchilles tendinopathy is ten-times more common amongst running athletes compared to age-matched peers. Load induced tendon remodeling and its progression in an at-risk population of developing symptomatic tendinopathy is not well understood. The purpose of this study was to prospectively characterize Achilles and patellar tendon structure in competitive collegiate distance runners over different competitive seasons using quantitative ultrasound imaging. Twenty-two collegiate cross country runners and eleven controls were examined for this study. Longitudinal and cross-sectional ultrasound images of bilateral Achilles and patellar tendons were obtained at the one week prior to start of formal collegiate cross country practices, one week after the conclusion of cross country season, and one week prior to outdoor track and field championships. Collagen organization, mean echogenicity, tendon thickness, and neovascularity were determined using well established image processing techniques. We found that Achilles and patellar tendons respond differently to high-volume running and transitions from one sport season to another, suggesting that tendon structure is sensitive to differences in tendon loading biomechanics. Our findings indicate that Achilles tendon structure in trained runners differ structurally to control tendons but is stable throughout training while patellar tendon structure changes in response to the transition in training volume between cross country and track seasons. These findings expand upon prior reports that some degree of tendon remodeling may act as a protective adaptation for sport specific loading.News and NoteworthyIn this study we prospectively examined the Achilles and patellar tendon structure of distance runners to determine if continued training through multiple seasons elicits tendon remodeling or pathology. We found that Achilles and patellar tendons respond uniquely to the changing loads required during each season. Achilles tendon collagen alignment is mostly stable throughout the competitive cycle, but the patellar tendon undergoes structural changes following the transition from cross-country to track season.

Acute-Onset Achilles Tendon Pain and Swelling Treated with an Amniotic Fluid–Derived Allograft: A Case Study

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Chad C. Carroll ◽  
Kali Chemelewski ◽  
Shivam H. Patel ◽  
Donald Curtis
Keyword(s):  
Extracellular Matrix ◽  
Amniotic Fluid ◽  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Acute Onset ◽  
Ankle Motion ◽  
Initial Injection ◽  
Before And After ◽  
Haglund Deformity ◽  
The Right

Background Tendinopathies are common musculoskeletal disorders that often develop because of chronic loading and failed healing. Tendinopathy related to systemic inflammation has been less extensively examined. Furthermore, although the use of biological agents to treat tendinopathies continues to gain popularity, the use of amniotic fluid–derived allografts in outpatient settings to resolve tendinopathies requires further evaluation. Methods The focus of this case report is a 25-year-old man who presented for a second opinion, having been diagnosed with Haglund deformity and Achilles tendinopathy. At the time of presentation, he complained of 10 of 10 pain to the right Achilles tendon. He was treating the injury conservatively with intermittent use of a controlled ankle motion boot and working with physiotherapy for approximately 5 months before presentation. Diagnostic ultrasound along with magnetic resonance imaging indicated distal thickening of the Achilles tendon, substantial fluid and edema in the Kager fat pad, and retrocalcaneal erosions with bursitis. Conservative management did not resolve the symptoms. As an alternative to surgery, the patient elected to undergo an Achilles tendon injection of an amniotic fluid–derived allograft. Before and after the initial injection, a microdialysis catheter was inserted into the Achilles peritendinous space to sample local levels of extracellular matrix enzymes and growth factors important for tendon remodeling. The patient received considerable relief with the initial injection, but did not return to full strength. Over the subsequent 8 weeks, the patient was followed closely and was able to return to daily activities with minimal pain. He was not able to return to a more active lifestyle without further Achilles pain, so a second amniotic fluid–derived allograft injection was performed 8 weeks after the initial injection. Results Injection of the initial allograft resulted in significant improvement, but not complete resolution of pain and swelling. Microdialysis findings suggested a reduction in peritendinous levels of the cytokine interlukin-6 in addition to changes in extracellular matrix regulatory enzymes. After 8 weeks of additional conservative therapy and a second injection, no further improvement in pain was noted. Conclusions Based on the clinical improvement of symptoms in this individual and the changes seen with microdialysis methodology, the authors find the use of amniotic fluid–derived allograft injection for treatment of Achilles pain in this patient to be a viable treatment. Additional comorbidities of systemic inflammatory polyarthritis and possible seronegative disease were addressed after rheumatology consultation with a variety of medications that provided the patient additional relief of his symptoms. The patient ultimately moved and was lost to further follow-up.

Prevalence of Asymptomatic Achilles Tendinosis

2018 ◽  
Vol 39 (10) ◽  
pp. 1205-1209 ◽  
Author(s):  
Peter C. Noback ◽  
Christina E. Freibott ◽  
Direk Tantigate ◽  
Eugene Jang ◽  
Justin K. Greisberg ◽  
...  
Keyword(s):  
At Risk ◽  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Significant Risk ◽  
Achilles Tendinopathy ◽  
Activity Level ◽  
Low Grade ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Asymptomatic Patients

Background: Most patients who sustain Achilles tendon ruptures (ATRs) have no clinical symptoms prior to ATR. The objective of this study was to define the prevalence of ultrasound-detectable Achilles tendinopathy in asymptomatic patients in an at-risk group. Methods: This was a cross-sectional study that collected data from a group of volunteers. All participants were given IPAQ questionnaires to gauge daily activity level, in addition to a demographic form. Participants underwent a physical examination, Silfverskiold test, and an ultrasonographic examination to evaluate for presence of Achilles tendinopathy. Fifty-one volunteers (30 female, 21 male) and 102 Achilles tendons were assessed in this study. The mean age was 27.4±6.3, with an average BMI of 23.5±3.9. Ninety-two percent of participants were categorized as having moderate or high activity levels per the iPAQ questionnaire. Results: Sixteen tendons had at least 1 abnormality: 10 (9.8%) had hypoechoic foci, 9 (8.8%) had calcifications, 1 (0.9%) had increased vascularity, and 1 (0.9%) had a low-grade interstitial tear. Approximately 40% of patients were noted to have a gastroc equinus contracture on Silfverskiold testing. In addition, 14.7% of patients with a gastroc equinus had a hypoechoic focus compared to 8.6% of patients without gastroc equinus ( P = .5003). Logistic regression analysis demonstrated that an increased BMI was a significant risk factor for having an Achilles tendon abnormality on ultrasonography ( P < .01, odds ratio = 1.41). Conclusion: In this study, 16% of the Achilles tendons were abnormal and had at least 1 abnormality on ultrasonography. This group of patients was generally young, healthy, and active, thus a group at risk for ATRs. Only 40% of patients had gastrocnemius equinus, although a slightly higher non-significant percentage of those with hypoechoic foci had gastrocnemius equinus. It may be advantageous to prophylactically treat these patients with rehabilitation exercises to minimize the risk of ATR. Level of Evidence: Level II, comparative prognostic study.

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