PRP treatment of Non-insertional Achilles Tendinopathy two case series: No significant difference in effect between Leukocyte-rich and Leukocyte-poor Platelet-Rich v1 (protocols.io.tk2ekye)

protocols.io ◽  
2018 ◽  
Author(s):  
Klaus Hanisch ◽  
Niels Wedderkopp
Keyword(s):  
Case Series ◽  
Achilles Tendinopathy ◽  
Significant Difference ◽  
Insertional Achilles Tendinopathy

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 Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092610
Author(s):  
Huai Ming Phen ◽  
Wesley J. Manz ◽  
Danielle Mignemi ◽  
Joel T. Greenshields ◽  
Jason T. Bariteau
Keyword(s):  
Linear Regression ◽  
Wound Infection ◽  
Surgical Management ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Complication Rates ◽  
Sf 36 ◽  
Significant Difference ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Effects of Achilles Tendon Moment Arm Length on Insertional Achilles Tendinopathy

2020 ◽  
Vol 10 (19) ◽  
pp. 6631
Author(s):  
Takuma Miyamoto ◽  
Yasushi Shinohara ◽  
Tomohiro Matsui ◽  
Hiroaki Kurokawa ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Moment Arm ◽  
Healthy Individuals ◽  
Suture Bridge ◽  
Significant Difference ◽  
The Moment ◽  
Insertional Achilles Tendinopathy ◽  
Suture Bridge Technique

Insertional Achilles tendinopathy (IAT) is caused by traction force of the tendon. The effectiveness of the suture bridge technique in correcting it is unknown. We examined the moment arm in patients with IAT before and after surgery using the suture bridge technique, in comparison to that of healthy individuals. We hypothesized that the suture bridge method influences the moment arm length. An IAT group comprising 10 feet belonging to 8 patients requiring surgical treatment for IAT were followed up postoperatively and compared with a control group comprising 15 feet of 15 healthy individuals with no ankle complaints or history of trauma or surgery. The ratio of the moment arm (MA) length/foot length was found to be statistically significant between the control group, the IAT group preoperatively and the IAT group postoperatively (p < 0.01). Despite no significant difference in the force between the control and preoperative IAT groups, a significantly higher force to the Achilles tendon was observed in the IAT group postoperatively compared to the other groups (p < 0.05). This study demonstrates that a long moment arm may be one of the causes of IAT, and the suture bridge technique may reduce the Achilles tendon moment arm.

Achilles tendoscopy for non insertional Achilles tendinopathy. A case series study

2020 ◽  
Vol 26 (4) ◽  
pp. 421-424
Author(s):  
Pablo Wagner ◽  
Emilio Wagner ◽  
Cristian Ortiz ◽  
Diego Zanolli ◽  
Andres Keller ◽  
...  
Keyword(s):  
Case Series ◽  
Achilles Tendinopathy ◽  
Case Series Study ◽  
Series Study ◽  
Insertional Achilles Tendinopathy

scholarly journals Anatomical footprint reconstruction for the treatment of insertional Achilles tendinopathy with heterotopic ossification

2020 ◽  
Author(s):  
Li Ma ◽  
Binghua Zhou ◽  
Zhenyu Wang ◽  
Guo Zheng ◽  
Xu Tao ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Operation Time ◽  
Achilles Tendinopathy ◽  
Clinical Effects ◽  
Exercise Recovery ◽  
Normal Walking ◽  
Significant Difference ◽  
The Mean ◽  
Insertional Achilles Tendinopathy

Abstract BackgroundThe aims of this study were to investigate the clinical outcomes of anatomical footprint reconstruction for the treatment of insertional Achilles tendinopathy (IAT) with heterotopic ossification and to provide an effective surgical method for the treatment of this condition.MethodsFrom October 2016 to October 2019, 10 patients underwent anatomical footprint reconstruction for the treatment of IAT with heterotopic ossification at our institution. The operation time and intraoperative bleeding volume were recorded. X-ray and MRI examinations of the calcaneus were performed after the operation. The American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS) and Victorian Institute of Sports Assessment–Achilles (VISA-A) scores were used to evaluate the clinical effects on the patients; the time to normal walking and exercise recovery was recorded; and the recovery rate of exercise was recorded at 6 months after the operation.ResultsThe average operation time was 64.4 min (45-74 min), the average bleeding volume was 29.7 ml (5-100 ml), and the average follow-up time was 22.4 months (12-48 months). The patients' wounds healed without infection, splitting, necrosis of the skin margin or other complications. The mean AOFAS score (± SD) was 70.3 ± 11.39 preoperatively and 94.2 ± 5.00 at the last follow-up, showing a significant difference between timepoints (P = 0.00; t = 7.657). The VAS score was 5.4 ± 1.71 preoperatively and 0.4 ± 0.51 at the last follow-up; this decrease was statistically significant (P = 0.00; t = 11.859). The mean VISA-A scores at the preoperative baseline and the last follow-up were 37.6 ± 16.39 and 81.4 ± 8.83, presenting a significant difference between the two timepoints (P = 0.00; t = 9.906). The average time to recover normal walking ability was 9.1 weeks (4-15 weeks), and the average time to resume exercise was 10 weeks (8-12 weeks). At 6 months after the operation, the rate of exercise recovery was 80%.ConclusionIn IAT with heterotopic ossification, anatomical footprint reconstruction enables patients to return to normal life and exercise quickly. The rate of return to sports is high, and the procedure offers satisfactory clinical effects.

scholarly journals Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

2020 ◽  
Vol 6 (1) ◽  
pp. e000769
Author(s):  
Håkan Alfredson ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Weight Bearing ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Full Weight Bearing ◽  
Bone Pathology ◽  
Level Of Evidence ◽  
Pain Mechanisms ◽  
Painful Condition ◽  
Insertional Achilles Tendinopathy

BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

scholarly journals Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

2021 ◽  
pp. 107110072110028
Author(s):  
Fabian Greiner ◽  
Hans-Jörg Trnka ◽  
Michel Chraim ◽  
Elena Neunteufel ◽  
Peter Bock
Keyword(s):  
Case Series ◽  
Operative Therapy ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Double Row ◽  
Postoperative Result ◽  
Foot Function ◽  
American Orthopaedic ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. Methods: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. Results: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively ( P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively ( P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up ( P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). Conclusion: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. Level of Clinical Evidence: Level IV, retrospective case series.

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