10-year follow-up after standardised treatment for Achilles tendinopathy

Abstract

BackgroundAchilles tendinopathy is a common and often long-lasting injury. We present a 10-year follow-up on a pragmatic study on Achilles tendinopathy treated with controlled exercises supplemented with corticosteroid injections if necessary in order to continue training.MethodsAll patients who completed the original study (n=93) were invited for a 10-year follow-up. 83% participated. Patients were evaluated with ultrasound scanning (n=58) and with a questionnaire (n=77) using the same outcome measures as in the primary study. The 10-year overall outcome on a 4-point scale (excellent, good, fair, poor), other treatments and adverse event and present activity level were recorded.ResultsExcellent outcome was reported in 63% and good outcome in 27%. 76% reported an activity level at 75%–100% of preinjury level. The average Victorian Institute of Sports Assessment-Achilles score for all patients was 84 (SD 19). 16% had surgery. Three ruptures occurred 5–8 years after the primary study. The improvement from entry to 6 months in the primary study was maintained until 10-year follow-up. Insertional tendinopathy did not differ from mid-substance tendinopathy in any outcome measure (short term and long term). We encountered no prognostic markers on ultrasound for the long-term outcome; however, present heterogeneity and increased flow resemble present pain. Thickened tendons seem to maintain their thickness despite improvement of symptoms.ConclusionOne to two corticosteroid injections are a safe and effective supplement to controlled exercises in the treatment of Achilles tendon pain with no signs of deterioration in the very long term. Mid-substance and insertional tendinopathies benefit equally from this treatment.

How many runners with new‐onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study

“…Johannsen et al 13 reported that 37% of patients with chronic AT experience some degree of pain and reduced function after 10 years follow-up, which is a similar to the 32% of self-reported persisting symptoms in our study. Noticeable is the small difference in persisting symptoms between our 1-year follow-up study and this 10-year follow-up study.…”

“…Noticeable is the small difference in persisting symptoms between our 1-year follow-up study and this 10-year follow-up study. 13 Other studies reported approximately 35%-60% of patients with chronic AT having persisting symptoms after a follow-up of 5 years or longer. 4, 14,15 The difference can be explained by the heterogeneity of the studies, as there were differences in the definition of recovery (self-reported recovery [13][14][15] vs pain free 4 ), type of AT (insertional, midportion, 4,15 or a mix 13,14 ), duration of AT (chronic AT vs 4,14 a mix of new-onset AT and chronic AT 13,15 ), and researched population (active patients 4,14 vs a mix of active and sedentary patients 13,15 ).…”

Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial

“…Despite initiation of treatments, two thirds of patients continue to have symptoms at one year follow-up 5. At 10 years follow-up, about a quarter of patients still have symptoms 56. About one third of these non-responders eventually require surgery 47.…”

“…5 At 10 years follow-up, about a quarter of patients still have symptoms. 5 6 About one third of these non-responders eventually require surgery. 4 7 Therefore, effective conservative treatment options are necessary to improve the outcome of patients with chronic Achilles tendinopathy who fail to respond to initial exercise treatment.…”

An analysis of functional outcome following tendon augmentation surgeries in patients presenting with steroid-induced tendo achilles rupture and spontaneous tendo achilles ruptures

“…Also in the steroid group late ruptures were noted at 5-8 years post steroid injection. 21 A meta-analysis done in 2010 by Coombes et al also showed poor outcomes with steroid injection. 22 In the present study (N=12), all of the patients (100%) had previous complaints of retrocalcaneal pain lasting for months prior to rupture and (N=6) 50% of the patients had received intralesional steroid injections in the last one year prior to rupture.…”