[Conservative Therapy of Achilles Tendinopathy in Sports Medicine]. / Konservative Therapie von Tendinopathien der Achillessehne in der Sportmedizin.

Conservative Therapy of Achilles Tendinopathy in Sports Medicine Abstract. Due to its key role in power transmission, the Achilles tendon is a common site of acute and overuse injuries in running athletes. Therefore, a sports physician needs to know some anatomic, diagnostic and therapeutic key points to be able to establish an individualized therapy approach. With regard to the «in¼ and «out of season¼ period, there is a primary focus on physio- and shock-wave therapy. Additionally, peritendinous infiltration might be re-evaluated in individual cases. In this review we focus on «midportion¼ and «insertional¼ tendinopathy. Nevertheless, conservative treatment of Achilles tendon ruptures will be discussed as well. This concise overview should provide the sports physician with basic knowledge of these common pathologies.

Atraumatic bilateral rupture of the peroneus brevis tendon in recreational sport: A case report.

ISSUE: Lower extremity tendon injuries often occur in physically active individuals. Most ruptures not involving great force are diagnosed in patients presenting underlying tendon degenerations. This also applies to patients taking medications because of a disease. We have observed several cases of bilateral Achilles tendon ruptures in patients who have been taking cortisone for a long period. We treated a healthy colleague (neurologist) in our clinic who sustained ruptures of the Achilles tendon on the left side (2012) and the peroneus brevis tendon on left side (2015) and right side (2016) after minimal traumata. Aim of this report is to provide a systematic review of this case and a literature review of similar cases, as few such cases have been published. METHODS: We reviewed and analysed this patient's records containing the sport-specific anamnesis, pre-existing condition, anamnesis of medications and therapy. The three injuries were magnetic resonance imaging-proven. Furthermore, the tendon's condition was examined histologically in the context of the operative treatment through lace technique of the Achilles tendon and transfer of the peroneus brevis to the peroneus longus. We also researched the literature for bilateral ruptures of the peroneal tendons. RESULTS AND CONCLUSION: The anamnesis confirmed no underlying disease. The patient took a macrolide antibiotic about half a year prior to the first peroneal injury for an otitis media. He denied having taken any other antibiotics, especially no quinolone antibiotics. However, the patient reported cortisone intake for 2 days some months before the second peroneal injury to treat an allergic reaction. That involved no local cortisone infiltration in the lower extremity. He underwent surgery within the first 2 weeks after each trauma. Each time, postoperative follow-ups revealed a good healing process. Three months after each operation, the patient was free of complaints. Axibal and Anderson described a patient with bilateral peroneus longus and peroneus brevis ruptures, as well as an Achilles tendon rupture on the left side plus tendinopathy of the Achilles tendon on the right side of uncertain aetiology. We detected additional similar cases in patients who had taken medications, especially cortisone and levofloxacine. Further research should be conducted to clarify other risk factors to help prevent such injuries.

Long-term biomechanical outcomes after Achilles tendon ruptures.

PURPOSE: The ideal treatment for Achilles tendon ruptures is still unknown. Biomechanical were correlated to radiological and clinical parameters to study outcomes. METHODS: In this retrospective, assessor-blinded multi-centre cohort study, 52 patients with unilateral Achilles tendon rupture were assessed, each at least 3 years after injury. Patients underwent open surgery, percutaneous surgery or non-surgical treatment of Achilles tendon rupture. Both legs underwent plantar pressure distribution and isokinetic measures. Demographic parameters, maximum calf circumference (MCC) and clinical scores (American Orthopaedic Foot and Ankle Society, Achilles tendon rupture score, Hannover) were also evaluated. Complications were not assessed. RESULTS: Peak plantar flexion torque (PPFT) was significantly weaker on the treated side compared to the untreated leg [80.4 ± 29.7 Nm (mean ± SD) vs. 92.1 ± 27.4 Nm, p < 0.0001]. PPFT and push-off force (POFF) were not different between treatment groups nor was there a leg difference in POFF alone. There was only a weak correlation of clinical scores and PPFT or POFF, respectively. MCC correlated significantly with both PPFT (R (2) = 0.21, p = 0.01) and POFF (R (2) = 0.29, p < 0.0001). POFF appeared to be a predictor of PPFT (R (2) = 0.31, p < 0.0001). Open surgery outperformed non-surgical treatment in terms of centre-of-pressure line (p = 0.007), torque per muscle volume (p = 0.04) and relative POFF per body weight (p = 0.02) and relative in side comparison (p = 0.03). CONCLUSIONS: Clinical scores do not predict biomechanical outcomes. Clinically measured MCC is a good predictor of PPFT and POFF and can easily be used in clinical practice. Relative POFF in side comparison as well as per body weight favours surgical treatment.

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures.

PURPOSE: The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed. METHODS: In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment. Demographic parameters, time off work, maximum calf circumference and clinical scores (ATRS, Hannover, AOFAS) were evaluated. Muscle volume and cross-sectional area of the calf and AT length were measured on MR images and were compared between groups and to each patient's healthy contralateral leg. RESULTS: Reduced muscle volume was found across all groups with a higher muscle volume in the conservative (729.9 ± 130.3 cm(3)) compared to the percutaneous group (675.9 ± 207.4 cm(3), p = 0.04). AT length was longer in the affected leg (198.4 ± 24.1 vs. 180.6 ± 25.0 mm, p < 0.0001) without difference in subgroup analysis. Clinically measured ankle dorsiflexion showed poor correlation with AT length (R (2) = 0.07, p = 0.008). Muscle volume strongly correlated with the cross-sectional area (R (2) = 0.6, p < 0.0001) but showed a weak correlation with the Hannover score (R (2) = 0.08, p = 0.048). Maximum calf circumference correlated with muscle volume (R (2) = 0.42, p < 0.0001). CONCLUSIONS: No significant difference between the treatment groups was found in muscle volume, AT length, clinical measures or days off work. Cross-sectional area and maximum calf circumference are cost-effective measurements and a good approximation of muscle volume and can thus be used in a clinical setting while clinical dorsiflexion should not be used.

Physiological Achilles tendon length and its relation to tibia length.

OBJECTIVE: The optimal intraoperative Achilles tendon length (ATL) adjustment is crucial for the physiological functioning of the musculotendinous unit. To date, the resting ATL and its relation to tibia length (TL) have never been defined in healthy subjects. We thus performed metric measurements of the ATL and TL. DESIGN: Case series. SETTING: Clinical and radiological measurements. PARTICIPANTS: Fifty-two subjects placed in a 3-T magnetic resonance imaging with the ankle in neutral position. MAIN OUTCOME MEASURES: Unilateral ATL measured from the calcaneal insertion to the beginning of the medial gastrocnemius muscle, TL measured from the intercondylar eminence to the center of the ankle, and qualitative tendon parameters in T2 sequences and human parameters were noted; results were correlated with age, gender, body height, weight, body mass index (BMI), and side of the AT and TL. RESULTS: The mean ATL was 180.6 ± 25.0 mm and the mean TL was 371.9 ± 25.4 mm with an ATL:TL ratio of 49 ± 5%. Achilles tendon length correlated significantly with body height (R = 38%, P < 0.0001) and with TL (R = 41%, P < 0.0001) but did not correlate with age, BMI, and side of the AT. Tibia length correlated with body height (R = 83%, P < 0.0001) and in multivariate linear regression, TL was the only independent predictor of ATL following the algorithm, ATL (mm) = 0.6 × TL (mm) - 53 (R = 41%). CONCLUSIONS: We defined a new way to measure the ATL in a consistent way in healthy subjects and showed correlations between ATL, TL and body height and defined an algorithm of ATL based on TL. The ATL and the ATL-algorithm might be important in patients with impaired tendons such as AT ruptures.