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Carrozzo A, Shatrov J, El Helou A, Pettinari F, Alayane A, Abed Ali A, Clechet J, Dutra Vieira T, Sonnery-Cottet B. Ultrasound-guided electrocoagulation of neovascularisation for persistent patellar tendinopathy in athletes: a cohort study of 25 patients with a mean follow-up of 5 years from the SANTI Study Group. BMJ Open Sport Exerc Med 2024; 10:e001900. [PMID: 38500579 PMCID: PMC10946354 DOI: 10.1136/bmjsem-2024-001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
Background Patellar tendinopathy (PT) is a common condition characterised by persistent patellar tendon pain and dysfunction, particularly in athletes. Neovascularisation is frequently observed in the PT and is associated with increased pain. Ultrasound-guided electrocoagulation of neovascularisation has emerged as a minimally invasive alternative treatment for recalcitrant PT. Hypothesis/purpose The purpose of this study was to evaluate the clinical outcomes of ultrasound-guided electrocoagulation of neovascularisation in athletes with persistent PT. Study design Case series; level of evidence, IV. Methods A retrospective analysis of prospectively collected data was performed on 25 athletes who underwent ultrasound-guided electrocoagulation of neovascularisation for recalcitrant PT. Clinical outcomes including complications, reinterventions and patient-reported outcome measures were recorded. Comparisons between variables were assessed using χ2 test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon test for quantitative variables. Results 25 patients were included in the final analysis. 96% returned to their preoperative activity level at a mean of 3.8 months. At a mean follow-up of 5 years 4% did not receive significant benefit from electrocoagulation therapy. Significant improvements were observed in outcome measures, including the Victorian Institute of Sport Assessment Questionnaire for Patients with Patellar Tendinopathy, Kujala score, modified Blazina score and Visual Analogue Scale for pain. Conclusion Ultrasound-guided electrocoagulation of neovascularisation for persistent PT in elite athletes resulted in a low complication rate, a high rate and rapid return to sport and a significant improvement in outcome measures.
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Affiliation(s)
- Alessandro Carrozzo
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy, Roma, Italy
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute, Landmark Orthopaedics, Sydney, New South Wales, Australia
| | - Abdo El Helou
- Mount Lebanon Hospital University Medical Center, Hazmiyeh, Lebanon
| | - Francesco Pettinari
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Ali Alayane
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Ahmad Abed Ali
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Julien Clechet
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, 24av Paul Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
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Ryan D, O’Donoghue G, Rio E, Segurado R, O’Sullivan C. The effect of combined Action Observation Therapy with eccentric exercises in the treatment of mid-portion Achilles-tendinopathy: a feasibility pilot randomised controlled trial. BMC Sports Sci Med Rehabil 2022; 14:201. [PMID: 36447250 PMCID: PMC9706872 DOI: 10.1186/s13102-022-00594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Mid-portion Achilles Tendinopathy (AT) is a common musculoskeletal condition with varying rehabilitation success rates. Despite the prevalence of this condition, a considerable proportion of individuals experience persisting pain and functional deficits. Current treatment approaches bias the biomedical model which emphasises physically treating and loading the tendon. Overall, there is a lack of consideration for the central nervous system that is commonly implicated in chronic injuries. The aim of this pilot study was to explore the feasibility of combining Action Observation Therapy (AOT), a treatment technique which targets central changes and influences motor learning, with eccentric exercises in the treatment of mid-portion AT. AOT involves the observation of movements and is commonly followed by the physical performance of these same movements. METHODOLOGY This was a double-blinded randomised controlled pilot feasibility study. All participants underwent the 12-week Alfredson eccentric training protocol. The intervention group watched videos of the exercises prior to performing these exercises, whilst the control group watched nature videos before performing the same exercises. Study feasibility was the primary outcome measure, with the Victorian Institute of Sports Assessment- Achilles (VISA-A) selected as the primary clinical outcome measure. RESULTS Thirty participants were recruited, reflecting a 75% eligibility rate and 100% of eligible participants enrolled in the study. The retention rate at week 12 was 80%. At week six the mean VISA-A score improved by 18.1 (95% CI 10.2-26.0) in the intervention group and 7.7 (95% CI 0.3-14.9) in the control group, and 75% and 33% of participants in the intervention and control group respectively exceeded the minimal clinically important difference (MCID). At week 12 the mean VISA-A score from baseline improved by 22.25 (95% CI 12.52-31.98) in the intervention group and 16.5-(95% CI 8.47-24.53) in the control group, equating to 75% and 58% in each group respectively exceeding the MCID. CONCLUSION The positive feasibility outcomes and exploratory data from the clinical outcome measures suggest that a larger scaled RCT is warranted to further investigate the impact of AOT in the rehabilitation of mid-portion AT. Trial registration ISRCTN58161116, first registered on the 23/12/2020.
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Affiliation(s)
- Deirdre Ryan
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
| | - Gráinne O’Donoghue
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
| | - Ebonie Rio
- grid.1018.80000 0001 2342 0938School of Allied Health, La Trobe University Melbourne, Melbourne, Australia
| | - Ricardo Segurado
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
| | - Cliona O’Sullivan
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, UCD, Dublin, Ireland
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Grävare Silbernagel K, Malliaras P, de Vos RJ, Hanlon S, Molenaar M, Alfredson H, van den Akker-Scheek I, Antflick J, van Ark M, Färnqvist K, Haleem Z, Kaux JF, Kirwan P, Kumar B, Lewis T, Mallows A, Masci L, Morrissey D, Murphy M, Newsham-West R, Norris R, O'Neill S, Peers K, Sancho I, Seymore K, Vallance P, van der Vlist A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 2022; 52:613-641. [PMID: 34797533 PMCID: PMC8891092 DOI: 10.1007/s40279-021-01588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION CRD42020156763.
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Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Mitchel Molenaar
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jarrod Antflick
- Department of Bioengineering, School of Engineering, Imperial College, London, UK
| | - Mathijs van Ark
- Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | | | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Arsenal Football Club, London, UK
| | - Jean-Francois Kaux
- Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhavesh Kumar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Trevor Lewis
- Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Myles Murphy
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Richard Newsham-West
- School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Norris
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Seth O'Neill
- School of Allied Health, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Kayla Seymore
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Patrick Vallance
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Arco van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
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Zhou H, Chen C, Zhang Y, Ugbolue UC. Ultrasound Color Doppler Measures Neovascularization in Achilles Tendinopathy: Review. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Color Doppler ultrasonography (CD) has been used to employ in Achilles tendinopathy, there is a need to measure neovascularization in Achilles tendinopathy to reach a consensus for CD application. The object of this systematic retrospect is to summarize
the literature regarding whether is a relationship between the neovascularization and Achilles tendinopathy by CD detecting. Method: The databases search of PubMed, Scopus, and Embase extracted 543 articles for title and abstract review. After deleting duplicate papers and evaluating
which one meets the inclusion criteria, a total of 8 articles were selected. Results and conclusion: Differentiate a physiological and pathological color Doppler flow in Achilles tendon is important to further clinically diagnose, since neovascularization in tissue structure can be
influenced by variation reasons. The standardized tenoangiography protocol be supposed to develop when assessment asymptomatic or symptomatic tendons.
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Affiliation(s)
- Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Chaoyi Chen
- School of Health and Life Sciences, University of the West of Scotland, Scotland, G72 0LH, UK
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Ukadike Chris Ugbolue
- School of Health and Life Sciences, University of the West of Scotland, Scotland, G72 0LH, UK
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Okewunmi J, Guzman J, Vulcano E. Achilles Tendinosis Injuries-Tendinosis to Rupture (Getting the Athlete Back to Play). Clin Sports Med 2020; 39:877-891. [PMID: 32892973 DOI: 10.1016/j.csm.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture.
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Affiliation(s)
- Jeffrey Okewunmi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Javier Guzman
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Ettore Vulcano
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Abstract
Non-insertional Achilles tendinopathy is a degenerative condition characterised by pain on activity.Eccentric stretching is the most effective treatment.Surgical treatment is reserved for recalcitrant cases.Minimally-invasive and tendinoscopic treatments are showing promising results. Cite this article: Pearce CJ, Tan A. Non-insertional Achilles tendinopathy. EFORT Open Rev 2016;1:383-390. DOI: 10.1302/2058-5241.1.160024.
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Affiliation(s)
| | - Audrey Tan
- Jurong Health Services Pte Ltd, Singapore
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7
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Drakonaki EE, Allen GM, Watura R. Ultrasound-guided intervention in the ankle and foot. Br J Radiol 2015; 89:20150577. [PMID: 26537692 DOI: 10.1259/bjr.20150577] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot.
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Affiliation(s)
| | - Gina M Allen
- 2 Department of Radiology, Oxford University Hospitals NHS Trust and St Lukes Radiology, Oxford, UK
| | - Roland Watura
- 3 Department of Radiology, North Bristol NHS Trust, Bristol, UK
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8
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Abstract
Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options.
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Affiliation(s)
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Muttini A, Russo V, Rossi E, Mattioli M, Barboni B, Tosi U, Maffulli N, Valbonetti L, Abate M. Pilot experimental study on amniotic epithelial mesenchymal cell transplantation in natural occurring tendinopathy in horses. Ultrasonographic and histological comparison. Muscles Ligaments Tendons J 2015; 5:5-11. [PMID: 25878980 PMCID: PMC4396678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND amnion-derived stem cells are considered a promising alternative source for tendon tissue regeneration. PURPOSE aims of this paper were to illustrate the ultrasound and histological outcomes following the treatment of acute and chronic superficial digital flexor tendon spontaneous lesions in horses with ovine amniotic epithelial cells xenotransplantation. METHODS six adult horses suffering from unilateral acute (4 cases) and chronic (2 cases) tendinopathy (clinical and ultrasound diagnosis) were enrolled. At baseline, ovine amniotic epithelial cells were grafted, in sterile conditions and under ultra-sound control, into the most damaged area. Ultra-sound controls were performed at 30, 60, 90, 120, 150 and 180 days after cells implantation; after horse euthanasia (180 days) tendon samples were collected and submitted to histological examination (cellularity, extracellular matrix fiber organization, blood vessels). RESULTS at baseline, in the acute cases, the ultra-sound exam showed a focal, dis-homogeneous, hypo-echoic area into the superficial digital flexor tendon, with loss of the normal fibrillar pattern, while in the chronic cases the damaged tendon area appeared thickened and completely hyper-echoic. At the final follow-up tendon echotexture was more regular, the cross-sectional area similar to the contra-lateral limb, and the collagen fibers were oriented in parallel to the longitudinal axis of the tendon both in the acute and chronic cases, suggesting a positive healing response. These findings were supported by the histological analyses which showed an almost complete restoration of normal tendon architecture with an optimal alignment of tendon fibers. CONCLUSIONS the present pilot study supports the hypothesis that amniotic epithelial cells are provided of an excellent healing potential and shows a very good correlation between the ultrasound findings and the histologic features.
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Affiliation(s)
- Aurelio Muttini
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Valentina Russo
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Elisabetta Rossi
- Viral Vaccines Institute, Serum and Diagnostics, Abruzzo and Molise Region Experimental Animal Health Care Institute “G. Caporale” (IZSAM), Teramo, Italy
| | - Mauro Mattioli
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Barbara Barboni
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Umberto Tosi
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Nicola Maffulli
- Department of Physical and Rehabilitation Medicine, University of Salerno, Azienda Ospedaliera San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Luca Valbonetti
- Department of Comparative Biomedical Sciences,University of Teramo, Italy
| | - Michele Abate
- Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, Chieti Scalo, Italy
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Lesniak BP, Loveland D, Jose J, Selley R, Jacobson JA, Bedi A. Use of ultrasonography as a diagnostic and therapeutic tool in sports medicine. Arthroscopy 2014; 30:260-70. [PMID: 24485118 DOI: 10.1016/j.arthro.2013.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/23/2013] [Accepted: 10/29/2013] [Indexed: 02/02/2023]
Abstract
Ultrasonography has many important advantages over other imaging modalities and many important applications in sports medicine. This article presents an evidence-based discussion of the use of ultrasound technology to diagnose and treat common musculoskeletal disorders, with emphasis on the shoulder, elbow, hip, knee, and foot and ankle. Topics include basic principles, scan artifacts, the appearance of musculoskeletal structure characteristics and pathologies, and various diagnostic and therapeutic applications in sports medicine.
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Affiliation(s)
- Bryson P Lesniak
- UHealth Sports Medicine, the Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Dustin Loveland
- UHealth Sports Medicine, the Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Jean Jose
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ryan Selley
- Section of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Asheesh Bedi
- Section of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
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11
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Wheeler P. What do patients think about diagnostic ultrasound? A pilot study to investigate patient-perceived benefits with the use of musculoskeletal diagnostic ultrasound in an outpatient clinic setting. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/175361410x12652805807954] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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Abstract
CONTEXT Tendinopathy is increasing in prevalence and accounts for a substantial part of all sports injuries and occupational disorders. Despite the magnitude of the disorder, high-quality scientific data on etiology and available treatments have been limited. EVIDENCE ACQUISITION The authors conducted a MEDLINE search on tendinopathy, or "tendonitis" or "tendinosis" or "epicondylitis" or "jumpers knee" from 1980 to 2011. The emphasis was placed on updates on epidemiology, etiology, and recent patient-oriented Level 1 literature. RESULTS Repetitive exposure in combination with recently discovered intrinsic factors, such as genetic variants of matrix proteins, and metabolic disorders is a risk factor for the development of tendinopathy. Recent findings demonstrate that tendinosis is characterized by a fibrotic, failed healing response associated with pathological vessel and sensory nerve ingrowth. This aberrant sensory nerve sprouting may partly explain increased pain signaling and partly, by release of neuronal mediators, contribute to the fibrotic alterations observed in tendinopathy. The initial nonoperative treatment should involve eccentric exercise, which should be the cornerstone (basis) of treatment of tendinopathy. Eccentric training combined with extracorporeal shockwave treatment has in some reports shown higher success rates compared to any therapies alone. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects but have no proven long-term treatment effects or meta-analyses to support them. For epicondylitis, cortisone injections have demonstrated poorer long-time results than conservative physiotherapy. Today surgery is less indicated because of successful conservative therapies. New minioperative procedures that, via the endoscope, remove pathologic tissue or abnormal neoinnervation demonstrate promising results but need confirmation by Level 1 studies. CONCLUSIONS Novel targeted therapies are emerging, but multicenter trials are needed to confirm the results of exercise and mini-invasive treatments.
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Affiliation(s)
- Paul W Ackermann
- Section of Orthopedics and Sports Medicine, Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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13
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The effect of acute exercise on collagen turnover in human tendons: influence of prior immobilization period. Eur J Appl Physiol 2012; 113:449-55. [PMID: 22790487 DOI: 10.1007/s00421-012-2450-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
Mechanical loading of human tendon stimulates collagen synthesis, but the relationship between acute loading responses and training status of the tendon is not clear. We tested the effect of prolonged load deprivation on the acute loading-induced collagen turnover in human tendons, by applying the same absolute load to a relative untrained Achilles tendon (2-week immobilization period prior to acute loading) and a habitually loaded contra-lateral Achilles tendon, respectively, within the same individuals. Eight untrained, healthy males had one lower limb totally immobilized for 2 weeks, whereas the contra-lateral leg was used habitually. Following the procedure both Achilles tendons and calf muscles were loaded with the same absolute load during a 1-h treadmill run. Tissue collagen turnover was measured by microdialysis performed post-immobilization but pre-exercise around both Achilles tendons and compared to values obtained by 72-h post-exercise. Power Doppler was used to monitor alterations in intratendinous blood flow velocity of the Achilles tendon and MRI used to quantitate changes in tendon cross-section area. Acute loading resulted in an increased collagen synthesis 72 h after the run in both Achilles tendons (p < 0.05) with no significant difference. No signs of acute tendon overloading were demonstrated by Power Doppler, and tendon cross-section area did not change as a result of immobilization and reloading. The present study indicates that 2 weeks of tendon load deprivation is not sufficient to affect the normal adaptive response to loading determined as increased collagen synthesis of peritendinous Achilles tendon tissue in humans.
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Lui TH. Treatment of chronic noninsertional Achilles tendinopathy with endoscopic Achilles tendon debridement and flexor hallucis longus transfer. Foot Ankle Spec 2012; 5:195-200. [PMID: 22392267 DOI: 10.1177/1938640011434508] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Decompression with debridement has been shown to be effective in pain management in patients with chronic mid-portion Achilles tendinopathy; however, augmentation with the flexor hallucis longus tendon can provide additional mechanical support. The technique of endoscopic debridement of the tendinopathic tendon together with flexor hallucis longus transfer is described to treat patients suffering from chronic painful noninsertional Achilles tendinopathy with the potential advantage of minimally invasive surgery. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, SAR, China.
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15
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Pearce CJ, Carmichael J, Calder JD. Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy. Foot Ankle Surg 2012; 18:124-7. [PMID: 22444000 DOI: 10.1016/j.fas.2011.04.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/14/2011] [Accepted: 04/28/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The mainstay of treatment for non-insertional Achilles tendinopathy is non-operative, however a proportion of patients will fail conservative measures. We describe the results of Achilles tendinoscopy with plantaris tendon release in patients who have failed first line conservative treatment for at least 6 months. METHODS A consecutive series of 11 patients with a minimum of 2 years follow up. RESULTS The mean AOFAS scores significantly improved from 68 pre-op to 92 post op (p=0.0002) as did the AOS scores for both pain (28% pre-op to 8% post op (p=0.0004)) and disability (38% pre-op to 10% post op (p=0.0005). The mean SF-36 scores also improved but were not statistically significant (pre-op 76, post op 87 (p=0.059). There were no complications. 8 of the 11 patients were satisfied, the other 3 somewhat satisfied. CONCLUSIONS The results of Achilles tendinoscopy and division of the plantaris tendon are encouraging but further studies are required to compare it to other treatments. It is minimally invasive and low risk so should not affect the ability to perform a formal open procedure if unsuccessful.
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Affiliation(s)
- Christopher J Pearce
- Department of Trauma and Orthopaedic Surgery, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
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Yang X, Coleman DP, Pugh ND, Nokes LDM. A novel 3-D power Doppler ultrasound approach to the quantification of achilles tendon neovascularity. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1046-1055. [PMID: 21640481 DOI: 10.1016/j.ultrasmedbio.2011.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/18/2011] [Accepted: 04/17/2011] [Indexed: 05/30/2023]
Abstract
To investigate the amount of neovascularization in the symptomatic Achilles tendon, we developed a novel three-dimensional (3-D) power Doppler ultrasound scanning system to prospectively examine 10 patients with 12 symptomatic Achilles tendons, as well as 20 asymptomatic Achilles tendons as a control group. The mean volume of neovascularity (VON) in the whole Achilles tendon was calculated during the phase of the cardiac cycle displaying maximum vascularity and also during the phase of the cardiac cycle displaying the minimum. The mean VONs in the control group were found to be 0.41 mm(3) (maximum) and 0.02 mm(3) (minimum), respectively. The mean VONs in patients with painful Achilles tendon were 380 mm(3) (maximum) and 70.3 mm(3) (minimum), respectively. The initial results showed that the 3-D power Doppler ultrasound system could be used to measure the mean VON in controls and in patients with symptomatic Achilles tendinopathy. The results demonstrated a significantly greater VON in the maximum phase compared with the minimum phase as well as in the patient group compared with that in the control group. The system was therefore capable of defining the degree of vascularity in the Achilles tendon.
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Affiliation(s)
- Xin Yang
- Institute of Medical Engineering and Medical Physics, School of Engineering, Cardiff University, Cardiff, United Kingdom.
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Sivan M, Brown J, Brennan S, Bhakta B. A one-stop approach to the management of soft tissue and degenerative musculoskeletal conditions using clinic-based ultrasonography. Musculoskeletal Care 2011; 9:63-68. [PMID: 21618397 DOI: 10.1002/msc.194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE One-stop clinics aim at assessment, investigation and initiating treatment in a single hospital visit. They have been proven to be cost-effective and to increase patient satisfaction in various specialties. The aim of this study was to describe the one-stop approach to managing soft tissue and degenerative musculoskeletal conditions using clinic-based musculoskeletal ultrasonography (MSUS). METHODS A retrospective case record review was carried out of patients assessed and managed in the musculoskeletal clinic by a musculoskeletal and sports physician over a 10-month period. RESULTS A total of 1,166 patients were assessed and managed in a total of 155 outpatient clinics. The age range of patients was 19 to 85 years (median age 45 years). The diagnoses included traumatic or overuse tendinopathy, degenerative arthritis, bursitis, acute/chronic sporting injuries and acute/chronic back pain. A total of 1,012 patients (87%) had conditions related to the appendicular system (shoulder girdle, upper limb, pelvic girdle and lower limb) and 154 patients were referred with spinal pain. All patients with appendicular system problems had a definite diagnosis and treatment initiated on the first visit to the clinic. In 658 (65%) patients, a diagnostic ultrasound was deemed an appropriate investigation to improve the accuracy of diagnosis and more than half of them (352 patients) needed ultrasound-guided injections as part of the management of their conditions. A portable GE Healthcare LOGIQe machine with a 10 MHz linear probe and colour Doppler flow imaging was used to perform all scans. No adverse incidents were reported. CONCLUSIONS The use of clinic-based MSUS enables a one-stop approach, reduces repeated hospital appointments and improves quality of care in an outpatient musculoskeletal clinic.
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Affiliation(s)
- Manoj Sivan
- Department of Rehabilitation Medicine, Chapel Allerton Hospital, Leeds, UK.
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18
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Davidson J, Jayaraman S. Guided interventions in musculoskeletal ultrasound: what’s the evidence? Clin Radiol 2011; 66:140-52. [PMID: 21216330 DOI: 10.1016/j.crad.2010.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 08/13/2010] [Accepted: 09/21/2010] [Indexed: 11/26/2022]
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Maffulli N, Longo UG, Loppini M, Denaro V. Current treatment options for tendinopathy. Expert Opin Pharmacother 2011; 11:2177-86. [PMID: 20569088 DOI: 10.1517/14656566.2010.495715] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Tendon disorders are frequent and are responsible for much morbidity, both in sport and the workplace. Although several therapeutic options are routinely used, very few well-conducted randomised prospective, placebo, controlled trials have been performed to assist in choosing the best evidence-based management. AREAS COVERED IN THIS REVIEW We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases over the years 1966 - 2010 to review the best evidence-based options for the management of patients with tendinopathy. WHAT THE READER WILL GAIN The reader will obtain information on the available medical and surgical therapies used to manage tendinopathy-related symptoms. The effectiveness of therapies, the length of management and the adverse effects are examined. TAKE-HOME MESSAGE Management of tendinopathy is often anecdotic and lacking well-researched scientific evidence. Teaching patients to control the symptoms may be more beneficial than leading them to believe that tendinopathy is fully curable.
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Affiliation(s)
- Nicola Maffulli
- Queen Mary University of London, Mile End Hospital, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, 275 Bancroft Road, London E1 4 DG, UK.
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20
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Yang X, Pugh ND, Coleman DP, Nokes LDM. Are Doppler studies a useful method of assessing neovascularization in human Achilles tendinopathy? A systematic review and suggestions for optimizing machine settings. J Med Eng Technol 2010; 34:365-72. [DOI: 10.3109/03091902.2010.497892] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Wijesekera NT, Chew NS, Lee JC, Mitchell AW, Calder JD, Healy JC. Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status. Skeletal Radiol 2010; 39:425-34. [PMID: 20119832 DOI: 10.1007/s00256-009-0873-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/24/2009] [Accepted: 12/28/2009] [Indexed: 02/02/2023]
Abstract
Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Whilst injections have traditionally been used to manage symptoms, recently described therapies may also have disease-modifying potential. Ultrasound provides the ability to guide therapeutic interventions, ensuring that treatment is delivered to the exact site of pathology. Treatments can be broadly categorised according to their intended therapeutic targets, although some may act through several possible mechanisms. In this article, we review the ultrasound-guided techniques currently used to treat chronic Achilles tendinopathy, with reference to the available literature. There is strong pilot-level evidence supporting the use of many of these techniques, although large definitive trials are lacking. An approach towards the management of chronic Achilles tendinopathy is suggested.
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Affiliation(s)
- Nevin T Wijesekera
- Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW109NH, UK
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Maffulli N, Longo UG, Loppini M, Spiezia F, Denaro V. New options in the management of tendinopathy. Open Access J Sports Med 2010; 1:29-37. [PMID: 24198540 PMCID: PMC3781852 DOI: 10.2147/oajsm.s7751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an "acute tendinopathy" is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy.
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Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile end Hospital, London, England
| | - Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
| | - Mattia Loppini
- Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
| | - Filippo Spiezia
- Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
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Abstract
Achilles tendinopathy is a painful condition that occurs commonly in both active and inactive individuals. It seems that this condition is painful as a result of ingrowth of neural structures and neovessels leading to poor healing, rather than from inflammatory mediators. Traditional conservative measures are often successful. There is a subset of patients who fail to respond to these measures, however, and this has led to the investigation of newer conservative techniques. This article provides a review of many of the emerging techniques in the treatment of Achilles tendinopathy.
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Affiliation(s)
- Jason E Lake
- Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Abstract
Tendon transfers are commonly used in the foot and ankle to restore function in neglected ruptures, reconstruct degenerated tendons, and correct deformity. The Achilles tendon is commonly afflicted by these problems because of the dominant role it plays in the mechanics of gait and running and its inherently poor blood supply. This article discusses the general principles of tendon transfers with regard to Achilles tendon function, the surgical techniques involved, and published results using these techniques. The goal is to provide the orthopedic foot and ankle surgeon with a wide variety of techniques to solve both the straightforward Achilles tendon problem as well as the difficult revision case.
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Affiliation(s)
- Johnny L Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste 1063, Chicago, IL 60612, USA.
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Mitchell AWM, Lee JC, Healy JC. The use of ultrasound in the assessment and treatment of Achilles tendinosis. ACTA ACUST UNITED AC 2009; 91:1405-9. [DOI: 10.1302/0301-620x.91b11.23060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of ultrasound in the diagnosis and management of disorders of the tendo Achillis is discussed. Some of the pathological processes which occur in Achilles tendinopathy can be identified by ultrasound, which may also be used to direct local treatment.
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Affiliation(s)
- A. W. M. Mitchell
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - J. C. Lee
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - J. C. Healy
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
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Abstract
Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management. The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.
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Affiliation(s)
- Jonathan D Rees
- Defence Medical Rehabilitation Centre, Surrey, United Kingdom
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Sengkerij PM, de Vos RJ, Weir A, van Weelde BJG, Tol JL. Interobserver reliability of neovascularization score using power Doppler ultrasonography in midportion achilles tendinopathy. Am J Sports Med 2009; 37:1627-31. [PMID: 19359416 DOI: 10.1177/0363546509332255] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Power Doppler ultrasonography is widely used to examine neovascularization in midportion Achilles tendinopathy. The reliability of the grading of the degree of neovascularization has not been examined previously. HYPOTHESIS Power Doppler ultrasonography can be performed with a high interobserver reliability to determine the neovascularization score in patients with midportion Achilles tendinopathy. STUDY DESIGN Case control study (diagnosis); Level of evidence, 4. METHODS Thirty-three symptomatic and 17 asymptomatic Achilles tendons from 25 consecutive patients were included for ultrasound examination. Victorian Institute of Sport Assessment-Achilles score was used to assess the severity of the Achilles tendinopathy. Each tendon was scored twice by different radiologists using the modified Ohberg score for neovascularization. RESULTS The intraclass correlation coefficient for interobserver reliability was 0.85. Neovascularization was observed in 70% (23/33) of the symptomatic tendons and in 29% (5/17) of the asymptomatic tendons. The Spearman correlation coefficient between the Victorian Institute of Sport Assessment-Achilles score and the degree of neovascularization was - 0.16 (P = .10). CONCLUSION An excellent interobserver reliability was found for determining the degree of neovascularization on power Doppler ultrasonography examination. Neovessels were present in a majority of symptomatic tendons. The severity of symptoms was not correlated with the neovascularization score. CLINICAL RELEVANCE Power Doppler ultrasonography is widely used to evaluate tendinopathy without knowledge of the difference in observations between several testers. Interobserver reliability of the evaluation of the degree of neovascularization in chronic midportion Achilles tendinopathy is excellent.
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28
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Longo UG, Ramamurthy C, Denaro V, Maffulli N. Minimally invasive stripping for chronic Achilles tendinopathy. Disabil Rehabil 2009; 30:1709-13. [DOI: 10.1080/09638280701786922] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Naidu V, Abbassian A, Nielsen D, Uppalapati R, Shetty A. Minimally invasive paratenon release for non-insertional Achilles tendinopathy. Foot Ankle Int 2009; 30:680-5. [PMID: 19589316 DOI: 10.3113/fai.2009.0680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Non-insertional Achilles tendinopathy is an increasing, perhaps secondary to an increase in sporting activities. Traditional open surgical procedures have been associated with a significant rate of complications. We describe a minimally invasive technique involving the release of the adherent paratenon with a peritendinous infusion of corticosteroids and present the results in a cohort of patients. MATERIALS AND METHODS Twenty-nine tendons (26 patients) with non-insertional Achilles tendinopathy were treated with the above technique. Assessments were made prospectively using an adapted classification of Achilles tendon disability and a visual analogue scale for pain. Patients were interviewed in person or by telephone at an average of 14 (range, 6 to 30) months after surgery. RESULTS The average pain score (VAS) improved from 8.7 to 2.4 (p < 0.001) and the average Puddu level of disability improved from 4.9 to 1.7 (p < 0.001). Seventy-five percent of patients had a good or excellent outcome with 20% having sufficient improvement not to pursue further medical attention for their tendinopathy. There was a 7% rate of minor complications due to delayed wound healing which resolved spontaneously and did not affect the rehabilitation or the recovery of the patients. CONCLUSION A minimally invasive circumferential paratenon release and peritendinous steroid infusion was a simple method to treat non-insertional Achilles tendinopathy and had low morbidity in our series. This technique has become our preferred primary surgical intervention for this condition.
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30
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Finnoff JT, Willick S, Akau CK, Harrast MA, Storm SA. Sports and Performing Arts Medicine: 6. Tendinopathy. PM R 2009; 1:S83-7. [DOI: 10.1016/j.pmrj.2009.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
PURPOSE The last decade has seen an evolution in the thinking of tendinopathy from inflammatory to degenerative and hence a change in approaches to treatment. METHOD We review the literature in this field to highlight the possibility of neural and neural-induced inflammation in this field. RESULTS Neuropathy is a possible source of pain in tendinopathy. CONCLUSION Further work is required to develop the neuropathic model of tendinopathy, and to determine whether these neuropathic factors are responsible. The concept of neoneurovascularization being the issue in tendinopathy is established. The underlying mechanisms for the process require further evaluation.
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Affiliation(s)
- A D J Webborn
- The Sussex Centre for Sport & Exercise Medicine, University of Brighton, Eastbourne, UK.
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32
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Clementson M, Lorén I, Dahlberg L, Aström M. Sclerosing injections in midportion Achilles tendinopathy: a retrospective study of 25 patients. Knee Surg Sports Traumatol Arthrosc 2008; 16:887-90. [PMID: 18551276 DOI: 10.1007/s00167-008-0568-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 05/06/2008] [Indexed: 10/22/2022]
Abstract
Sclerosing injections under ultrasonographic guidance is a new method of treatment for persistent pain in Achilles tendinosis. Good results, even superior to those of surgery, have been described. We report the outcome of 25 patients with midportion tendinosis receiving sclerosing treatment. Twenty-eight consecutive patients (29 tendons) with ultrasonographical findings of midportion tendinosis examined during the period November 2004 to November 2005 were identified in the database of the Department of Radiology, Malmö University Hospital. Twenty-five patients (26 tendons) were found suitable for treatment. Follow-up consisted of self-assessment questionnaire or phone interview. In 19 patients (20 tendons), results were good or excellent. Complications were few and mild. We conclude that sclerosing injections is a promising alternative to surgery in chronic Achilles midportion tendinosis. Our results are comparable to those obtained with surgery, but the procedure is less invasive. However, a few cases of tendinosis lack detectable neovessels and may still be candidates for surgery.
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Affiliation(s)
- Martin Clementson
- Department of Orthopedics, Malmö University Hospital, 205 02, Malmö, Sweden.
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Affiliation(s)
- Aaron T Scott
- Division of Orthopaedic Surgery, Duke University Medical Center, Duke University, Durham, NC 27704, USA
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