Management of Insertional Achilles Tendinopathy

Jie, Cheng; Janney, Cory; Khalid, Mohammed Asad; Panchbhavi, Vinod K.

doi:10.5435/jaaos-d-21-00679

Cited by 10 publications

(13 citation statements)

References 41 publications

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“…7,8 Although the exact pathophysiology of IAT is not well understood, in the athletic population it is thought to be due to repetitive and excessive load on the Achilles tendon. 7,8 In those with a sedentary lifestyle, obesity, or metabolic/endocrine comorbidities, it is thought to be secondary to altered microvascularity. 14 Diminished microvascular flow to end organs leads to limited healing capability of damaged tissues, including the Achilles tendon.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study

Purnell,

Johnson,

Cody

2023

Foot Ankle Int.

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Background: Insertional Achilles tendinopathy (IAT) is a common condition causing pain and dysfunction. Patients with diabetes, hyperlipidemia, hypothyroidism, and obesity are at increased risk of developing IAT. These comorbidities also carry an increased risk of wound healing complications following surgery. Therefore, there is a need for alternative management strategies for this high-risk patient population. This study investigated the potential role of isolated GR in patients with chronic IAT. Methods: This study is a single-institution retrospective review of adult patients who underwent isolated GR to address chronic IAT with a minimum 1-year follow-up. Demographics, complications, radiographic findings, and preoperative and postoperative patient-reported outcome scores (PROs) were collected. The primary outcome was improvement in PROMIS scores from preoperative to postoperative. Secondary outcomes were complication and reoperation rates. Results: Sixteen patients underwent open GR with a mean follow-up of 2.7 years. Postoperative PROMIS domain scores improved significantly from preoperative scores for physical function, pain interference, pain intensity, and global physical function. Two patients (13%) underwent reoperation (open calcaneal exostectomy and tendon debridement) at a mean time of 7 months from gastrocnemius recession. One patient developed a postoperative hematoma that resolved with conservative management. Conclusion: This single-institution series reports on a small cohort of patients with chronic IAT treated with open GR. We found significant improvement in patient-reported outcomes. Rates of complication and reoperation were low. This study supports the potential use of isolated gastrocnemius recession in IAT patients who, because of age or medical comorbidities, may benefit from a less invasive surgery and faster rehabilitation. Level of Evidence: Level III, retrospective case control study.

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Section: Introductionmentioning

confidence: 99%

“…Commonly, patients develop a traction heel spur at the Achilles insertion site or calcific deposition within the distal tendon substance leading to the term insertional calcific Achilles tendinopathy (ICAT). 7…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study

Purnell,

Johnson,

Cody

2023

Foot Ankle Int.

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“…Achilles tendinopathy (AT) occurs in approximately 1.85 per 1000 people and presents with functional restriction, pain and swelling at the calcaneal insertion (insertional AT) or 2–6 cm proximal to the calcaneal insertion (non-insertional AT) [ 9 , 19 , 24 , 26 ]. While the exact aetiology of AT is not clear, it is believed to involve degeneration or failed adaptation of the Achilles tendon to activity [ 9 , 10 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…First line management for AT is non-operative; however, after 6 months of non-operative treatment, up to 45.5% of patients may remain symptomatic and undergo operative intervention [ 1 , 9 , 21 , 28 , 41 , 43 ]. Surgical strategies may include: debridement of fibrotic adhesions and regions of failed healing, controlled longitudinal incisions to the tendon to restore vascularity and stimulate a healing response, graft augmentation and removal of neovessels and associated nerves [ 25 , 31 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

Arshad

Shdefat

Iqbal

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose This systematic review aims to summarise the outcomes of gastrocnemius release in the management of Achilles Tendinopathy. Methods A systematic review was performed according to PRISMA guidelines. A computer-based search was performed in PubMed, Embase, Cinahl, Scopus and ISI Web of Science. Two independent reviewers performed both title/abstract and full-text screening according to a-priori selection criteria. English-language original research studies reporting outcomes for gastrocnemius recession in patients with Achilles tendinopathy were included. Study quality and risk of bias were assessed using the MINORS criteria. Results Of the 229 articles identified following database searching, nine studies describing 145 cases of gastrocnemius recession were included in the review. Clinically important differences were reported across a range of validated patient reported outcome scores including VISA-A, FFI, FAAM and VAS pain score. Outcomes appear to be superior in patients with noninsertional Achilles tendinopathy, however further research is required to confirm this. Studies also reported an increase in ankle dorsiflexion range of motion and a good rate of return to sport/work. The overall complication rate was 10/123 (8.1%), with sural nerve injury being the most common complication, occurring in 5/123 (4.1%) of cases. Conclusion The results of this review suggest gastrocnemius release to be an effective treatment option in the management of patients with Achilles tendinopathy, who have gastrocnemius contracture and have previously failed to respond adequately to non-operative treatment. Level of evidence Level IV.

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“…Conservative treatment, including physical therapy, injection and extracorporeal shock wave, is usually suggested as the first-line management [ 9 ]. Corticosteroid is one of the most common agents in local injection and showed its short-term therapeutic effects compared with other treatments [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Cross-Linked Hyaluronate and Corticosteroid Combination Ameliorate the Rat Experimental Tendinopathy through Anti-Senescent and -Apoptotic Effects

Hsu

Chen

et al. 2022

IJMS

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The combination of cross-linked hyaluronate (cHA) and corticosteroid showed more rapid pain or functional improvement in knee osteoarthritis and adhesive capsulitis. However, rare evidence of this combination in treating tendinopathy has been reported. We hypothesized that the specific formulations of cHA and dexamethasone (DEX) conferred amelioration of tendinopathy via anti-apoptosis and anti-senescence. In this controlled laboratory study, primary tenocytes from the human tendinopathic long head of biceps were treated with three cHA formulations (cHA:linealized HA = 80:20, 50:50, and 20:80) + DEX with or without IL-1β stimulation. Cell viability, inflammatory cytokines, tendon-related proliferation markers, matrix metalloproteinases (MMPs), senescent markers, and apoptosis were examined. The in vivo therapeutic effects of the selected cHA + DEX combinations were evaluated in a collagenase-induced rat patellar tendinopathy model. The expression levels of inflammatory mediators, including IL-1β, IL-6, COX-2, MMP-1, and MMP-3 were significantly reduced in all cHA + DEX-treated tenocytes (p < 0.05, all). The cHA (50:50) + DEX and cHA (20:80) + DEX combinations protected tenocytes from cytotoxicity, senescence, and apoptosis induced by DEX in either IL-1β stimulation or none. Furthermore, the two combinations significantly improved the rat experimental tendinopathy by reducing ultrasound feature scores and histological scores as well as the levels of apoptosis, senescence, and senescence-associated secretory phenotypes (p < 0.05, all). We identified two specific cHA formulations (cHA (50:50) and cHA (20:80)) + DEX that could ameliorate tendinopathy through anti-senescence and -apoptosis without cytotoxicity. This study provides a possible approach to treating tendinopathy using the combination of two well-known agents.

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Management of Insertional Achilles Tendinopathy

Cited by 10 publications

References 41 publications

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study

Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

Cross-Linked Hyaluronate and Corticosteroid Combination Ameliorate the Rat Experimental Tendinopathy through Anti-Senescent and -Apoptotic Effects

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