Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique

Benazzo, Francesco; Zanon, Giacomo; Klersy, Catherine; Marullo, Matteo

doi:10.1007/s00167-014-3232-x

Cited by 10 publications

(14 citation statements)

References 49 publications

(94 reference statements)

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“…The majority of shoulder pain is associated with rotator cuff tendinopathy (RCT) [ 2 , 3 ]. Tendon pain is more common in people with rotator cuff tears than those with normal tendons [ 4 ], however there is a poor association between the severity of symptoms and extent of structural change [ 5 , 6 ] and current non-operative strategies are focused on steroid-based therapies with mixed results. There is a need to better understand the role of the peripheral tissue in tendinopathy-related pain to inform novel therapeutic options, possible pathways involve the glutaminergic and inflammatory systems [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy

et al. 2015

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IntroductionThe relationship between peripheral tissue characteristics and pain symptoms in soft tissue inflammation is poorly understood. The primary aim of this study was to determine immunohistochemical differences in tissue obtained from patients with persistent pain and patients who had become pain-free after surgical treatment for rotator cuff tendinopathy. The secondary aim was to investigate whether there would be differences in glutaminergic and inflammatory gene expression between disease-derived and healthy control cells in vitro.MethodsSupraspinatus tendon biopsies were obtained from nine patients with tendon pain before shoulder surgery and from nine further patients whose pain had resolved completely following shoulder surgery. Histological markers relating to the basic tendon characteristics, inflammation and glutaminergic signalling were quantified by immunohistochemical analysis. Gene expression of glutaminergic and inflammatory markers was determined in tenocyte explants derived from painful rotator cuff tendon tears in a separate cohort of patients and compared to that of explants from healthy control tendons. Dual labelling was performed to identify cell types expressing nociceptive neuromodulators.ResultsTendon samples from patients with persistent pain demonstrated increased levels of metabotropic glutamate receptor 2 (mGluR2), kainate receptor 1 (KA1), protein gene product 9.5 (PGP9.5), CD206 (macrophage marker) and CD45 (pan-leucocyte marker) versus pain-free controls (p <0.05). NMDAR1 co-localised with CD206-positive cells, whereas PGP9.5 and glutamate were predominantly expressed by resident tendon cells. These results were validated by in vitro increases in the expression of mGluR2, N-methyl-D-aspartate receptor (NMDAR1), KA1, CD45, CD206 and tumour necrosis factor alpha (TNF-α) genes (p <0.05) in disease-derived versus control cells.ConclusionsWe conclude that differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of shoulder pain in rotator cuff tendinopathy, and that disease-derived cells exhibit a distinctly different neuro-inflammatory gene expression profile to healthy control cells.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0691-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy

et al. 2015

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“…Clinical studies using open debridement techniques reported reasonable outcomes but wound complications have been a concern, especially when the angiosomal pattern of the posterior heel was not respected. A recent comparative study found superior outcomes when a transfer of soleus muscle bellies into the debrided Achilles tendon was added 86. Alfredson reported success in the use of ultrasound-guided small incision for the release of Achilles tendon from the ventral soft tissue in 519 patients with the recurrence rate of 5% 87.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Achilles tendinopathy: state of the art

Ackermann

Phisitkul²,

Pearce

2018

Journal of ISAKOS

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“…Particularly high complication rates were observed in studies evaluating the outcome of multiple tenotomies via an open procedure [4, 18, 21]. …”

Section: Discussionmentioning

confidence: 99%

Surgical treatment for midportion Achilles tendinopathy: a systematic review

Baltes

Zwiers

Wiegerinck

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of this study was to systematically evaluate the available literature on surgical treatment for midportion Achilles tendinopathy and to provide an overview of the different surgical techniques.MethodsA systematic review of the literature available in MEDLINE, EMBASE and the Cochrane database of controlled trials was performed. The primary outcome measure in terms of patient satisfaction and the secondary outcome measures that consisted of complication rate, pain score, functional outcome score and success rate were evaluated. The Downs & Black checklist and the Coleman methodology scale were used to assess the methodological quality of included articles.ResultsOf 1090 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 1285 procedures in 1177 patients. The surgical techniques were divided into five categories. Eleven studies evaluated open surgical debridement, seven studies described minimally invasive procedures, three studies evaluated endoscopic procedures, one study evaluated open gastrocnemius lengthening, and one study reported on open autologous tendon transfer. Results regarding patient satisfaction (69–100 %) and complication rate (0–85.7 %) varied widely.ConclusionsThis study demonstrates the large variation in surgical techniques available for treatment of midportion Achilles tendinopathy. None of the included studies compared surgical intervention with nonsurgical or placebo intervention. Minimally invasive and endoscopic procedures yield lower complication rates with similar patient satisfaction in comparison with open procedures. Minimally invasive and endoscopic procedures might therefore prove to be the future of surgical treatment of Achilles midportion tendinopathy.Level of evidenceIV.

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Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique

Abstract: Prospective comparative study, Level II.

Cited by 10 publications

References 49 publications

Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy

Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy

Treatment of Achilles tendinopathy: state of the art

Surgical treatment for midportion Achilles tendinopathy: a systematic review

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