Noninsertional Tendinopathy of the Achilles

Singh, Amrik; Calafi, Arash; Diefenbach, C.; Kreulen, Christopher; Giza, Eric

doi:10.1016/j.fcl.2017.07.006

Cited by 31 publications

(22 citation statements)

References 97 publications

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“…Rahm et al suggested to perform FHL transfer after failure of local debridement, failure of free tendon grafting in case of a tendon defect or advanced fatty in ltration of the TS. (6) A minimal defect of 50% of the tendon was determined as an indication for the need of a tendon transfer by several authors (7,10,11,24) Lin et al (25) presented an algorithm for the treatment of chronic Achilles tendinopathy based on the presence or absence of stumps on preoperative MRI and the defect gap measured intra-operatively. FHL transfer was considered when the tendon stumps did not have enough integrity.…”

Section: Discussionmentioning

confidence: 99%

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Wirth

Andronic

Aregger

et al. 2020

Preprint

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Background: The purpose of this study was to outline indirect signs of advanced Achilles tendinopathy on magnetic resonance imaging (MRI) and develop a potential tool that could aid in surgical decision-making.Methods: Magnetic resonance imaging (MRI) scans of Achilles tendon were analyzed retrospectively in two consecutive cohorts. Control group consisted of patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4 to 5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the flexor hallucis longus (FHL). Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both quotients to assess potential cut-off points.Results: A total of 60 patients for each study group were included. The ratios for area and for diameter showed significant higher values for FHL in the tendinopathy group (p<0.001). There was strong to very strong interobserver agreement (rho=0.744). A diameter ratio FHL/TS of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.Conclusion: In our patient cohort, flexor hallucis longus hypertrophy was observed even before a tendon transfer was employed as a possible compensatory mechanism for Achilles tendon tendinopathy. Using the tool described in this study, measuring a value of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

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Section: Discussionmentioning

confidence: 99%

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Wirth

Andronic

Aregger

et al. 2020

Preprint

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show abstract

“…Rahm et al suggested to perform FHL transfer after failure of local debridement, failure of free tendon grafting in case of a tendon defect or advanced fatty in ltration of the TS. (6) A minimal defect of 50% of the tendon was determined as an indication for the need of a tendon transfer by several authors (7,10,11,25) Lin et al (26) presented an algorithm for the treatment of chronic Achilles tendinopathy based on the presence or absence of stumps on preoperative MRI and the defect gap measured intra-operatively. FHL transfer was considered when the tendon stumps did not have enough integrity.…”

Section: Another Area Of Need For An Additional Objective Tool Is Thementioning

confidence: 99%

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Wirth

Andronic

Aregger

et al. 2020

Preprint

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Background: The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL).Methods: MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, whilst the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4 to 5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cut-off points to differentiate between the groups.Results: A total of 60 patients for each study group were included. Both ratios, Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p<0.001). There were strong to very strong intraclass correlation coefficients (ICC=0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.Conclusion: In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

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“…Achilles tendinopathy is confirmed by a clinical symptom triad of pain, swelling, and limited function [5]. Achilles tendon injuries are classified by the anatomical area into noninsertional and insertional.…”

Section: Introductionmentioning

confidence: 99%

“…e intrinsic factors include impaired blood supply, gastrocnemiussoleus dysfunction, age, sex, body weight, metabolic disorders, lateral ankle instability, foot joint hypermobility, and foot deformities. e extrinsic factors that might contribute to Achilles tendinopathy are several sport disciplines (volleyball, basketball, and running), changes in training schedules, training errors, past injuries, inadequate footwear, and unsuitable training surfaces [1,5,[9][10][11][12]. Repetitive tendon strain (3-8%) promotes cumulative microtrauma [1].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy for Achilles Tendinopathy

Stania

Juras

Chmielewska

et al. 2019

BioMed Research International

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Extracorporeal shock wave therapy (ESWT) is among the conservative treatments for Achilles tendinopathy. Unfortunately, no optimal application parameters have been determined that would ensure ESWT effectiveness in this condition. The aim of the paper is to use research reports on ESWT in patients with Achilles tendinopathy to help practising physiotherapists establish the most effective intervention parameters. A search was conducted using the following databases: PubMed, Scopus, EBSCOhost, and Web of Science. The papers were checked for relevant content and were included based on the following criteria: full-text article published in English and including comprehensive description of shock wave application. Twenty-two articles met the inclusion criteria. Most studies on the effectiveness of ESWT for Achilles tendinopathy included in this narrative review were randomized controlled trials. Two case-control studies, a case series study, prospective audit, clinical trial protocol, and a pilot study were also considered. The majority were prospective studies. Only a few authors presented the findings from retrospective observations. The two modalities of shock wave therapy used for Achilles tendinopathy are focused shock waves and radial shock waves. The literature contains reports presenting mainly beneficial effects of ESWT in patients with Achilles tendinopathy.

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Noninsertional Tendinopathy of the Achilles

Cited by 31 publications

References 97 publications

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Extracorporeal Shock Wave Therapy for Achilles Tendinopathy

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