Achilles tendinopathy – pathophysiology: state of the art

Ackermann, Paul W.; Phisitkul, Phinit; Pearce, Christopher J.

doi:10.1136/jisakos-2017-000164

Cited by 8 publications

(4 citation statements)

References 92 publications

(63 reference statements)

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“…Indeed, both ischemia fibrocartilagelike tissue are common features of midportion Achilles tendinopathies. 13,25 However, these possibilities remain speculative. Therefore, prospective studies are needed to verify whether athletes with Achilles tendinopathy do indeed have a higher degree of tendon torsion.…”

Section: Discussionmentioning

confidence: 99%

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Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Pringels,

Stouthandel,

Van Hoof

et al. 2023

Scandinavian Med Sci Sports

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Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound‐guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight‐knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.

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Section: Discussionmentioning

confidence: 99%

“…Second, chondrogenic metaplasia might occur as the tenocytes try to adapt the tendon structure to this compressive load, a process known as mechanotransduction. Indeed, both ischemia and fibrocartilage‐like tissue are common features of midportion Achilles tendinopathies 13,25 . However, these possibilities remain speculative.…”

Section: Discussionmentioning

confidence: 99%

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Pringels,

Stouthandel,

Van Hoof

et al. 2023

Scandinavian Med Sci Sports

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“…In a study by Rolf and Movin,12 18 of 58 patients with ‘achillodynia’ did not perform any vigorous physical activity. Holmes and Lin in a retrospective study also found statistically significant correlations between tendinopathy and metabolic disorders such as diabetes mellitus, obesity and hypertension, as well as underlying inflammatory disorders and intake of different drugs, see separate article on aetiology13 (Figure 1). Therefore, these risk factors should be elicited in the history 14…”

Section: Introductionmentioning

confidence: 90%

Treatment of Achilles tendinopathy: state of the art

Ackermann

Phisitkul²,

Pearce

2018

Journal of ISAKOS

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“…The etiology and pathomechanism of Achilles tendinopathy (AT) are still poorly understood, but seem to be multi-factorial. 1,2 Achilles tendons withstand forces of ~2600 N during walking and ~9000 N during running. 2 However, what causes the decline of its resilience?…”

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confidence: 99%

Mechanotendography in Achillodynia shows reduced oscillation variability of pre-loaded Achilles tendon: a pilot study

Schaefer

Bittmann

2020

Eur J Transl Myol

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The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95% confidence intervals (CI) of MTG results were disjoint, whereas the 95% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.

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Achilles tendinopathy – pathophysiology: state of the art

Cited by 8 publications

References 92 publications

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Treatment of Achilles tendinopathy: state of the art

Mechanotendography in Achillodynia shows reduced oscillation variability of pre-loaded Achilles tendon: a pilot study

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