Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review

Abstract

Achilles tendinopathy is a common musculoskeletal disorder. Athletes, runners and jumpers, and the sedentary are frequently affected. Numerous are the therapeutic choices to manage these kinds of disorders. The aim of this review is to analyze the available literature to document the up-to-date evidence on conservative management of Achilles tendinopathy. A systematic review of two medical electronic databases was performed by three independent authors, using the following inclusion criteria: conservative treatment consisted of pharmacologic, physical therapy without operative treatment, with more of 6 months symptoms and a minimum average of 6-months follow-up. Studies of any level of evidence, reporting clinical results, and dealing with Achilles tendinopathy and conservative treatment were searched for. A total of n = 1228 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 94 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 29 articles. Achilles tendinopathy is a frequent musculoskeletal disorder and several conservative treatments have been proposed, but no therapy is universally accepted, except for eccentric exercise training, which is the gold standard and a commonly used protocol.

An Overview of Achilles Tendinopathy Management

“…The rehabilitation team made up of medical doctors, physiotherapists and athletic trainers should work in synergy, sharing a timeline and short, medium, and long-term goals for a complete recovery. The patient with AT should start an early rehabilitation program, under physiotherapist supervision, including eccentric exercises whose effectiveness has been demonstrated, indeed a recent systematic review confirmed that among the several conservative treatments of AT, the only one universally accepted as a gold standard is the eccentric exercise widely used in the clinical trials included in the review [86]. In addition to physical exercise, other conservative therapies can be used, such as the use of ESWT, physical therapies and the use of injections.…”

Functional Outcome at Short and Middle Term of the Extracorporeal Shockwave Therapy Treatment in Lateral Epicondylitis: A Case-Series Study

“…The reason of the ESWT beneficial action could be detected in the mechanical stimulus provided, which promotes increased pro-inflammatory mediators such as interleukins and metalloproteases [11]. Waugh et al analyzed the in vivo the biological response to extracorporeal shockwaves, and they showed that in the dialysate tendon, there were some predominant cytokines, some of which had an elevated concentration immediately after ESWT, and then remained significantly elevated for several hours post-ESWT [25].…”

“…ESWT has become a widely employed approach in different musculoskeletal pathologies, including the upper limb soft tissues diseases [9], chronic Achilles tendinopathy [10] and plantar fasciitis [11]. Although the therapeutic mechanism of this treatment is controversial, some studies suggested that the shear stress and compression forces induced and maintained by ESWT should stimulate the extracellular matrix binding proteins and endothelial cell homeostasis and the reaction of the bonelacuno-canalicular [12], which should promote the neovascularization, improve angiogenesis, enhance tissue perfusion and reduce the necrotic zone and tissue apoptosis [13][14][15].…”

Functional biomaterials for tendon/ligament repair and regeneration

“…Thus, they have good application prospects. At present, the most difficult problem with the action of growth factors at sites of injury is the difficulty associated with achieving their sustained and controllable release and the control of the inflammatory response after the stent enters the body [ 173 ]. The combination of biomimetic nanoparticles (NPS) and scaffolds represents a new approach to promoting the sustained and effective release of drugs and growth factors [ 174 ].…”