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Nonoperative Treatment of Achilles Tendinopathy

아킬레스 건병증의 비수술적 치료

  • Jeong, Jae Jung (Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 정재중 (가톨릭대학교 의과대학 대전성모병원 정형외과학교실)
  • Received : 2021.04.08
  • Accepted : 2021.05.17
  • Published : 2021.06.15

Abstract

Achilles tendinopathy has seen good results with conservative management. However, the management of Achilles tendinopathy lacks evidence-based support, and tendinopathy patients are at risk of long-term morbidity with unpredictable clinical outcomes. Data suggests that 29% of tendinopathy patients required surgical intervention during the follow-up period. Chronic pain after damage to the Achilles tendon is a result of incomplete recovery of fibrous tissue. Recently, many procedures, including various injection treatments, have been tried without understanding proper preservation techniques and procedures for faster tendon recovery, especially for patients who want to quickly return to their daily lives. This article is an extensive literature review on nonoperative management of Achilles tendinopathy.

Keywords

References

  1. Paavola M, Kannus P, Paakkala T, Pasanen M, Jarvinen M. Long-term prognosis of patients with achilles tendinopathy. An observational 8-year follow-up study. Am J Sports Med. 2000;28:634-42. doi: 10.1177/03635465000280050301.
  2. Maffulli N, Longo UG. Conservative management for tendinopathy: is there enough scientific evidence? Rheumatology (Oxford). 2008;47:390-1. doi: 10.1093/rheumatology/ken011.
  3. Maffulli N, Longo UG, Kadakia A, Spiezia F. Achilles tendinopathy. Foot Ankle Surg. 2020;26:240-9. doi: 10.1016/j.fas.2019.03.009.
  4. The Korean Foot & Ankle Society. Textbook of the foot and ankle. 2nd ed. Seoul: Panmuneducation; 2019. p.306-7.
  5. Uquillas CA, Guss MS, Ryan DJ, Jazrawi LM, Strauss EJ. Everything Achilles: knowledge update and current concepts in management: AAOS exhibit selection. J Bone Joint Surg Am. 2015;97:1187-95. doi: 10.2106/JBJS.O.00002.
  6. Maffulli N, Longo UG. How do eccentric exercises work in tendinopathy? Rheumatology (Oxford). 2008;47:1444-5. doi: 10.1093/rheumatology/ken337.
  7. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9:42-7. doi: 10.1007/s001670000148.
  8. Roos EM, Engstrom M, Lagerquist A, Soderberg B. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy: a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14:286-95. doi: 10.1111/j.1600-0838.2004.378.x.
  9. Maffulli N, Walley G, Sayana MK, Longo UG, Denaro V. Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil. 2008;30:1677-84. doi: 10.1080/09638280701786427.
  10. Fahlstrom M, Jonsson P, Lorentzon R, Alfredson H. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc. 2003;11:327-33. doi: 10.1007/s00167-003-0418-z.
  11. Glaser T, Poddar S, Tweed B, Webb CW. Clinical inquiries. What's the best way to treat Achilles tendinopathy? J Fam Pract. 2008;57:261-3.
  12. Neeter C, Thomee R, Silbernagel KG, Thomee P, Karlsson J. Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain. Scand J Med Sci Sports. 2003;13:376-82. doi: 10.1046/j.1600-0838.2003.00305.x.
  13. DaCruz DJ, Geeson M, Allen MJ, Phair I. Achilles paratendonitis: an evaluation of steroid injection. Br J Sports Med. 1988;22:64-5. doi: 10.1136/bjsm.22.2.64.
  14. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-59. doi: 10.4137/CMAMD.S39160.
  15. Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Br J Sports Med. 2011;45:421-8. doi: 10.1136/bjsm.2009.057968.
  16. Morath O, Kubosch EJ, Taeymans J, Zwingmann J, Konstantinidis L, Sudkamp NP, et al. The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy-a systematic review including meta-analysis. Scand J Med Sci Sports. 2018;28:4-15. doi: 10.1111/sms.12898.
  17. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502-8. doi: 10.1097/01.prs.0000138251.07040.51.
  18. Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med. 2003;33:381-94. doi: 10.2165/00007256-200333050-00004.
  19. Vannini F, Di Matteo B, Filardo G, Kon E, Marcacci M, Giannini S. Platelet-rich plasma for foot and ankle pathologies: a systematic review. Foot Ankle Surg. 2014;20:2-9. doi: 10.1016/j.fas.2013.08.001.
  20. Guelfi M, Pantalone A, Vanni D, Abate M, Guelfi MG, Salini V. Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy. Foot Ankle Surg. 2015;21:178-81. doi: 10.1016/j.fas.2014.11.005.
  21. Kang SH, Choi MS, Kim HK, Kim WS, Bae TH, Kim MK, et al. Polydeoxyribonucleotide improves tendon healing following achilles tendon injury in rats. J Orthop Res. 2018;36:1767-76. doi: 10.1002/jor.23796.
  22. Schulze-Tanzil G, Mobasheri A, Clegg PD, Sendzik J, John T, Shakibaei M. Cultivation of human tenocytes in high-density culture. Histochem Cell Biol. 2004;122:219-28. doi: 10.1007/s00418-004-0694-9.
  23. Pins GD, Christiansen DL, Patel R, Silver FH. Self-assembly of collagen fibers. Influence of fibrillar alignment and decorin on mechanical properties. Biophys J. 1997;73:2164-72. doi: 10.1016/S0006-3495(97)78247-X.
  24. Suh DS, Lee JK, Yoo JC, Woo SH, Kim GR, Kim JW, et al. Atelocollagen enhances the healing of rotator cuff tendon in rabbit model. Am J Sports Med. 2017;45:2019-27. doi: 10.1177/0363546517703336.
  25. Kim JH, Kim DJ, Lee HJ, Kim BK, Kim YS. Atelocollagen injection improves tendon integrity in partial-thickness rotator cuff tears: a prospective comparative study. Orthop J Sports Med. 2020;8:2325967120904012. doi: 10.1177/2325967120904012.
  26. Lee HS, Oh KJ, Moon YW, In Y, Lee HJ, Kwon SY. Intra-articular injection of type I atelocollagen to alleviate knee pain: a double-blind, randomized controlled trial. Cartilage. Published online August 2, 2019; doi: 10.1177/1947603519865304.
  27. Longo UG, Olivia F, Denaro V, Maffulli N. Oxygen species and overuse tendinopathy in athletes. Disabil Rehabil. 2008;30:1563-71. doi: 10.1080/09638280701785643.
  28. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004;86:916-22. doi: 10.2106/00004623-200405000-00005.
  29. Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2007;28:1064-8. doi: 10.3113/FAI.2007.1064.
  30. Kane TP, Ismail M, Calder JD. Topical glyceryl trinitrate and noninsertional Achilles tendinopathy: a clinical and cellular investigation. Am J Sports Med. 2008;36:1160-3. doi: 10.1177/0363546508314423.
  31. Ogden JA, Toth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res. 2001;(387):8-17. doi: 10.1097/00003086-200106000-00003.
  32. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs. J Foot Ankle Surg. 2002;41:16-22. doi: 10.1016/s1067-2516(02)80005-9.
  33. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003;21:984-9. doi: 10.1016/S0736-0266(03)00104-9.
  34. Rompe JD, Nafe B, Furia JP, Maffulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35:374-83. doi: 10.1177/0363546506295940.
  35. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43:752-61. doi: 10.1177/0363546514531911.
  36. Al-Abbad H, Simon JV. The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review. Foot Ankle Int. 2013;34:33-41. doi: 10.1177/1071100712464354.
  37. Costa ML, Shepstone L, Donell ST, Thomas TL. Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial. Clin Orthop Relat Res. 2005;440:199-204. doi: 10.1097/01.blo.0000180451.03425.48.
  38. Courville XF, Coe MP, Hecht PJ. Current concepts review: noninsertional Achilles tendinopathy. Foot Ankle Int. 2009;30:1132-42. doi: 10.3113/FAI.2009.1132.
  39. Irwin TA. Current concepts review: insertional Achilles tendinopathy. Foot Ankle Int. 2010;31:933-9. doi: 10.3113/FAI.2010.0933.
  40. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current concepts review update: insertional Achilles tendinopathy. Foot Ankle Int. 2017;38:1160-9. doi: 10.1177/1071100717723127.