Achilles Tendon Lesions in Sport

Williams, J. G. P.

doi:10.2165/00007256-199316030-00006

Cited by 117 publications

(48 citation statements)

References 81 publications

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“…Clearly, in acute trauma extrinsic factors predominate, whereas in chronic disorders intrinsic and extrinsic factors commonly interact. 12,13 Examples of intrinsic factors are tendon vascularity, gastrocnemius-soleus dysfunction, age, gender, body weight and height, pes cavus, and lateral ankle instability. Excessive motion of the hindfoot in the frontal plane, especially a lateral heel strike with compensatory pronation, is thought to cause a 'whipping action' on the Achilles tendon and predispose it to tendinopathy.…”

Section: Aetiology and Pathophysiologymentioning

confidence: 99%

Achilles tendinopathy: aetiology and management

Maffulli

Sharma

Luscombe

2004

JRSM

222

120

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Section: Aetiology and Pathophysiologymentioning

confidence: 99%

Achilles tendinopathy: aetiology and management

Maffulli

Sharma

Luscombe

2004

JRSM

222

120

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“…Proximal pain at the muscle-tendon junction has been reported to be relatively uncommon (Williams, 1986), although it is considered to be the weakest point in the muscle-tendon and therefore susceptible to strain injuries (Józsa & Kannus, 1997b …”

Section: Proximal Pain At the Muscle-tendon Junctionmentioning

confidence: 99%

Magnetic resonance imaging in chronic achilles tendinopathy

Shalabi

2004

Acta Radiol

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The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI-techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium enhanced T1-WI images (CME T1-WI) and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic painful Achilles tendinosis, before -and two years after -surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated to the histopathological findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 seconds) was seen in DEMRI in the symptomatic Achilles tendons with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed growing MRI-technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter-and intra-observer reliability. The technique was also used to prospectively follow up the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of one year we evaluated the biological effect of tendon repair following iatrogenic tendon injury by five transversal ultrasound-guided core-biopsies employing a needle technique in chronic Achilles tendinopathy. Alterations found during healing, such as tendon volume and intratendinous reactive changes could be monitored by MR imaging, and subsided as noted in the seven and twelve months follow-up. In study V, we evaluated the effect of treatment with three months daily-performed heavy loaded calf muscle strength training program in 25 patients who had been suffering from chronic painful Achilles tendinopathy. The tendon volume decreased with 14%, and the mean intratendinous signal with 23%. The clinical outcome was improved. In study VI, we revealed tendon adaptation immediately following calf muscle strength training. An MRI examination within 30 minutes of the performed exercises resulted in increased total tendon volume (12%) and mean intratendinous signal (31%).In conclusion, MRI-techniques can be used as an adjunct to clinical evaluation by monitoring morphological effects following different treatment interventions, thereby ...

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“…El mecanismo de lesión incluye un repentino empujón de la parte delantera del pie que soporta el peso con la rodilla en extensión, una dorsiflexión inesperada y una violenta dorsiflexión de un pie en flexión plantar 12 . En cuanto a la etiología, han sido propuestos muchos factores posibles 13 , tales como una pobre vascularización del tendón y degeneración del mismo 13,14 , disfunción gastro-sólea 13 , efectos adversos de algunos fármacos (por ejemplo corticoesteroides 15,16 y fluoroquinolonas 17,18 ) y la hipertermia inducida por el ejercicio 19,20 . El diagnóstico se realiza basado en la palpación de un hueco y en una prueba de Thompson positiva, aunque si el examen físico es equívoco, la ecografía o la resonancia magnética se pueden emplear para confirmarlo 3,21,22 .…”

Section: Introductionunclassified

Tratamiento quirúrgico frente al conservador para la ruptura aguda del tendón de Aquiles

Olivera

2018

Rev. Int. Cienc. Podol.

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Resumen. Introducción: La reparación quirúrgica es un método común para el tratamiento de la ruptura aguda del tendón de Aquiles, ya que, a pesar de presentar un mayor riesgo de complicaciones, ofrece un menor riesgo de rotura recurrente. Sin embargo, análisis recientes basados en el empleo de rehabilitación funcional temprana, han cuestionado esta creencia. El objetivo de este estudio consiste en evaluar la efectividad clínica de ambos tratamientos. Metodología: Se han empleado cuatro bases de datos (Medline, CINAHL, PubMed y Cochrane Library) para la búsqueda de estudios que comparen el tratamiento quirúrgico y el conservador para la ruptura aguda del tendón de Aquiles. La selección de los artículos se realizó en función de los criterios de inclusión y exclusión. Resultados: Los estudios mostraron que el tratamiento quirúrgico presenta una tasa inferior de rotura recurrente (P=0.002) en comparación con el conservador, pero aumenta el riesgo de otras complicaciones (P=0.004). Un análisis de subgrupos reveló una tasa significativamente más alta en relación con la adherencia cicatricial (P<0.00001), la infección superficial (P=0.05) y la perturbación de la sensibilidad (P=0.0003) en el grupo sometido a cirugía. Conclusiones: El tratamiento quirúrgico, en comparación con el conservador, puede reducir eficazmente el riesgo de rotura recurrente, pero incrementa la probabilidad de complicaciones, lo cual suele estar asociado a la cirugía de reparación abierta. No obstante, no hay pruebas suficientes de estudios actuales que apoyen la creencia de que la cirugía puede conducir a una mejor recuperación funcional. Palabras clave: ruptura aguda tendón Aquiles; tratamiento conservador; tratamiento quirúrgico.[en] Surgical versus Conservative Treatment for Acute Achilles Tendon Rupture Abstract. Background: Surgical repair is a common method of treatment of acute Achilles tendon rupture because, despite a higher risk of overall complications,it has been believed to offer a reduced risk of rerupture. However, recent analysis based on using early functional rehabilitation, have challenged this belief. The aim of this study is to evaluate the clinical effectiveness of both treatments. Methods: The search was performed using the following electronic bibliography databases (Medline, CINAHL, PubMed and Cochrane Library) to find studies comparing surgical and conservative treatment for acute Achilles tendon rupture. The selection of items was based on inclusion and exclusion criteria. Results: The studies showed that surgical treatment has a lower rate of rerupture (P=0.002) compared with nonsurgical treatment, but increases the risk of other complications (P=0.004). Subgroup analyses revealed significant differences in relation to scar adhesion (P<0.00001), superficial infection (P=0.05) and sensibility disturbance (P=0.0003) in the group undergoing surgery. Conclusions: Compared with conservative treatment, operative treatment can effectively reduce the risk of rerupture but increase the probability of complications, which is us...

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Achilles Tendon Lesions in Sport

Cited by 117 publications

References 81 publications

Achilles tendinopathy: aetiology and management

Achilles tendinopathy: aetiology and management

Magnetic resonance imaging in chronic achilles tendinopathy

Tratamiento quirúrgico frente al conservador para la ruptura aguda del tendón de Aquiles

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