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Achilles Tendon Ailments: From the Bedside to the Bench

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (1 July 2022) | Viewed by 23539

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Special Issue Editors

Prof. Dr. Francesco Oliva

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Guest Editor

Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy
Interests: arthroplasty; shoulder; hip; knee; ankle and foot surgery; tendinopathies
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Nicola Maffulli

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Guest Editor

1. Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
2. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
3. Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Fisciano, Italy
Interests: orthopaedic
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Disorders of the Achilles tendon, the largest tendon in the human body, are common and occur in both active and sedentary individuals. Achilles tendon ruptures and tendinopathies do not heal very well, and outcome assessment after surgery and rehabilitation are not evidence-based. Associated dysmetabolic conditions and overuse seem to be the most important associated risk factors, although the etiopathogenesis often remains unclear. Clinically, acute and chronic Achilles tendon conditions show different presentations and outcomes. Any intervention should consider comorbid conditions in addition to patients’ lifestyle to help guide decision making. This Special Issue will focus on all recent advances from the bedside to the bench to clarify the role of surgery, rehabilitation, and regenerative medicine in the management of Achilles tendon ailments.

Prof. Dr. Francesco Oliva
Prof. Dr. Nicola Maffulli
Guest Editors

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Keywords

achilles disorders
achilles ruptures
achilles tendinopathy
achilles surgery
achilles rehabilitation
achilles regeneration

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Published Papers (7 papers)

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Research

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11 pages, 276 KiB

Open AccessArticle

Effect of Platelet-Rich Plasma Augmentation on Endoscopy-Assisted Percutaneous Achilles Tendon Repair

by Chun-Yu Hung, Shih-Jie Lin, Chia-Yi Yeh and Wen-Ling Yeh

J. Clin. Med. 2022, 11(18), 5389; https://doi.org/10.3390/jcm11185389 - 14 Sep 2022

Cited by 3 | Viewed by 1817

Abstract

Background: Achilles tendon ruptures are one of the most common sports injuries. Recently, platelet-rich plasma (PRP) has been widely used in tendon-related disorders to enhance tendon healing. However, studies regarding PRP treatment in Achilles tendon rupture show inconsistent results. The purpose of this study was to evaluate the effectiveness of PRP in patients with acute Achilles tendon rupture treated with endoscopy-assisted percutaneous repair. Methods: A total of 62 patients with acute Achilles tendon rupture treated with surgical repair from January 2014 to December 2018 were enrolled in this study. Surgical repair in conjunction with PRP augmentation after surgery was classified as the PRP group. Surgical repair without PRP augmentation was classified as the non-PRP group. All patients were followed up at least 2 years post-operation. The outcomes were evaluated on the basis of rate of return to sports, time to return to play, Achilles Tendon Total Rupture Score (ATRS), calf circumference ratio, ankle range of motion (ROM) and complications following surgery. Results: At 2-year follow-up, the ATRS score was not significantly different between groups (p = 0.8), but the ATRS score in both groups improved with time. Rate of return to sports and time to return to play were not different between the two groups (p = 1.00). Moreover, calf circumference ratio and ankle ROM were evaluated at 6-month, 12-month, 18-month and 24-month follow-ups. At 6 months, the PRP group had better ankle ROM (p = 0.003) and a higher calf circumference ratio (p = 0.011); however, at the 24-month evaluation, there were no between-group differences regarding calf circumference ratio, ankle dorsiflexion and plantarflexion (p > 0.05). Conclusion: We show that PRP augmentation in Achilles tendon surgery did not yield superior functional and clinical outcomes. Therefore, clinicians should inform patients of the above information when undergoing Achilles tendon surgery and offer correct expectations to family and patients regrading PRP treatment. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

12 pages, 408 KiB

Open AccessArticle

Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study

by Francesco Oliva, Emanuela Marsilio, Giovanni Asparago, Alessio Giai Via, Carlo Biz, Johnny Padulo, Marco Spoliti, Calogero Foti, Gabriella Oliva, Stefania Mannarini, Alessandro Alberto Rossi, Pietro Ruggieri and Nicola Maffulli

J. Clin. Med. 2022, 11(13), 3698; https://doi.org/10.3390/jcm11133698 - 27 Jun 2022

Cited by 25 | Viewed by 2707

Abstract

Introduction: Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Materials and methods: Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. Results: “Return to work activities/sport” was negatively predicted by the presence of a metabolic disorder (β = −0.451; OR = 0.637) and ‘open’ surgery technique (β = −0.389; OR = 0.678). “Medical complications” were significantly predicted by metabolic disorders (β = 0.600 (0.198); OR = 1.822) and was negatively related to ‘mini-invasive’ surgery (i.e., not ‘open’ nor ‘percutaneous’) (β = −0.621; OR = 0.537). “Immediate weightbearing” and “immediate walking without assistance” were negatively predicted by ‘open’ technique (β = −0.691; OR = 0.501 and β = −0.359 (0.174; OR = 0.698)). Conclusions: Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

20 pages, 4744 KiB

Open AccessArticle

Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM)

by Andrzej Czamara and Łukasz Sikorski

J. Clin. Med. 2022, 11(12), 3335; https://doi.org/10.3390/jcm11123335 - 10 Jun 2022

Cited by 1 | Viewed by 2018

Abstract

Background: The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. Material: Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. Methods: A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). Results: Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). Conclusions: Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

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18 pages, 4222 KiB

Open AccessArticle

Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

by Łukasz Sikorski and Andrzej Czamara

J. Clin. Med. 2021, 10(22), 5299; https://doi.org/10.3390/jcm10225299 - 15 Nov 2021

Cited by 2 | Viewed by 2504

Abstract

The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

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10 pages, 5123 KiB

Open AccessArticle

Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture—A Pilot Study

by Łukasz Paczesny, Jan Zabrzyński, Marcin Domżalski, Maciej Gagat, Miron Termanowski, Dawid Szwedowski, Łukasz Łapaj and Jacek Kruczyński

J. Clin. Med. 2021, 10(11), 2370; https://doi.org/10.3390/jcm10112370 - 28 May 2021

Cited by 6 | Viewed by 4751

Abstract

Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

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Review

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10 pages, 1678 KiB

Open AccessReview

Advances in Microscopic Studies of Tendinopathy: Literature Review and Current Trends, with Special Reference to Neovascularization Process

by Łukasz Jaworski, Maria Zabrzyńska, Anna Klimaszewska-Wiśniewska, Wioletta Zielińska, Dariusz Grzanka and Maciej Gagat

J. Clin. Med. 2022, 11(6), 1572; https://doi.org/10.3390/jcm11061572 - 13 Mar 2022

Cited by 8 | Viewed by 3353

Abstract

Tendinopathy is a process of chaotic extracellular matrix remodeling followed by increased secretion of enzymes and mediators of inflammation. The histopathological assessment of tendinous tissue is crucial to formulate the diagnosis and establish the severity of tendon degeneration. Nevertheless, the microscopic analysis of tendinous tissue features is often challenging. In this review, we aimed to compare the most popular scales used in tendon pathology assessment and reevaluate the role of the neovascularization process. The following scores were evaluated: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score. Moreover, the role of neovascularization in tendon degeneration was reassessed. The Bonar system is the most commonly used in tendon pathology. According to the literature, hematoxylin and eosin with additional Alcian Blue staining seems to provide satisfactory results. Furthermore, two observers experienced in musculoskeletal pathology are sufficient for tendinopathy microscopic evaluation. The control, due to similar and typical alterations in tendinous tissue, is not necessary. Neovascularization plays an ambiguous role in tendon disorders. The neovascularization process is crucial in the tendon healing process. On the other hand, it is also an important component of the degeneration of tendinous tissue when the regeneration is incomplete and insufficient. The microscopic analysis of tendinous tissue features is often challenging. The assessment of tendinous tissue using the Bonar system is the most universal. The neovascularization variable in tendinopathy scoring systems should be reconsidered due to discrepancies in studies. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

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18 pages, 3045 KiB

Open AccessReview

Extensive Ossification of the Achilles Tendon with and without Acute Fracture: A Scoping Review

by Daniel Sullivan, Allison Pabich, Ryan Enslow, Avery Roe, Donald Borchert, Keenan Barr, Bailey Cook and Amanda Brooks

J. Clin. Med. 2021, 10(16), 3480; https://doi.org/10.3390/jcm10163480 - 6 Aug 2021

Cited by 5 | Viewed by 4898

Abstract

Extensive Ossification of the Achilles Tendon (EOAT) is an uncommon condition characterized by the presence of heterotopic ossification within the substance of the Achilles Tendon and is distinct from other tendinopathies associated with tendon mineralization. The purpose of this scoping review of the literature on EOAT is to describe the pathogenesis, patient population, presentation, management, and outcomes of this rare condition. Fifty-four articles were included in the scoping review after screening and selection. According to the literature, EOAT often presents with pain and swelling around the Achilles Tendon and is frequently associated with acute trauma. EOAT is more common in men, and although the exact mechanisms of the pathology are not fully understood, EOAT may demonstrate specific molecular signaling patterns. The lack of knowledge regarding the molecular mechanism may be a significant hindrance to the management of the condition. Even though a standard treatment regimen for EOAT does not exist, conservative management for six months in patients without complications is recommended. Those who have an acute fracture of the ossification should be managed more aggressively and will often require surgical repair with autograft, although there is no standardized procedure at this time. Clinicians should be aware of the typical presentation, risk factors, and management options of patients with EOAT. Additionally, they should be cautious when selecting treatment strategies and conduct a thorough evaluation of long-term outcomes with various treatment modalities, which this review provides. Most important, this review highlights the need for further research to determine the best course of clinical treatment of EOAT injuries, in order to establish a standard treatment regimen. Full article

(This article belongs to the Special Issue Achilles Tendon Ailments: From the Bedside to the Bench)

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