Håkan Alfredson

Håkan Alfredson
Umeå University | UMU · Department of Community Medicine and Rehabilitation

MD, PhD, Professor
Clinical work (non surgical and surgical treatment) and research on tendinopathy.

About

225
Publications
86,154
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15,669
Citations
Citations since 2016
38 Research Items
5209 Citations
20162017201820192020202120220200400600800
20162017201820192020202120220200400600800
20162017201820192020202120220200400600800
20162017201820192020202120220200400600800

Publications

Publications (225)
Article
Full-text available
Background and Objectives: Ultrasound (US) and Doppler (DP) guided arthroscopic shaving targeting the area with neovessels and nerves on the dorsal side of the tendon has shown good clinical results. Recently, we observed that in a sub-group of patients there is also local tenderness on the superficial side of the proximal patellar tendon; Material...
Article
Full-text available
Background: Delayed Achilles tendon ruptures leaving large defects are difficult to treat, and the potential for tendon regeneration is thought to be limited. Furthermore, post-operative wound healing problems, sometimes including infections, can be challenging to treat and negatively affect rehabilitation. Case presentation: This 74-year-old la...
Article
Full-text available
Background Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated.Objective To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in pro...
Article
Full-text available
Purpose: Chronic painful quadriceps tendinopathy is a relatively rare condition known to be difficult to manage. Conservative management is first-line treatment and if that fails open intra-tendinous revision surgery followed by a long rehabilitation period is used. There is sparse research on etiology and new treatment methods. This observational...
Article
Full-text available
Background Plantaris tendinopathy and plantaris-associated Achilles tendinopathy can be responsible for chronic pain in the Achilles tendon midportion, often accompanied by medial tenderness. As conservative treatments are less successful for this patient group, proper diagnosis is important for decision making. This report presents a case with pla...
Article
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Background: Studies have demonstrated that a sub-group of patients with medial Achilles pain exhibit Achilles tendinopathy with plantaris tendon involvement. This clinical condition is characterised by structural relationships and functional interference between the two tendons, resulting in compressive or shearing forces. Surgical plantaris tendo...
Article
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(1) Background: Reconditioning of the paraspinal lumbar extensor muscles by isolated lumbar extension resistance exercises (ILEX) has shown good clinical results for patients with chronic unspecific low back pain. However, the clinical value and safety for patients with specific spine pathologies is unclear. In this study, clinical outcome and infl...
Article
Full-text available
Objectives Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible p...
Article
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Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points...
Article
PurposeThe present study aims to analyze the accuracy of injections aimed to hit the proximal and depth part of the patellar tendon “target point” in patellar tendinopathy, comparing ultrasound-guided or non-ultrasound-guided (blind) injections.MethodsA cadaver randomized study was carried out. Injections were performed under ultrasound control, as...
Article
Full-text available
There is a need for effective therapeutic options for resistant patellar tendinopathy. Ultrasound (US)-guided arthroscopic debridement has demonstrated promising clinical results. Objectives To prospectively evaluate pain, function, tendon structure and adverse events after US and colour Doppler (CD)-guided arthroscopic debridement for persistent...
Article
Full-text available
Background Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneo...
Article
Isolated neuropathy of the superficial peroneal nerve (SPN) is a relatively rare type of peripheral neuropathy. It is linked to the mechanical entrapment of the SPN in predisposed locations of its anatomical pathway. Associated clinical findings are insufficient lifting of the latero-dorsal part of the foot, stepping on the lateral border of the fo...
Article
Background: The absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busil...
Article
Full-text available
We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the Intern...
Conference Paper
Introduction Tendinopathy (local tendon pain associated with physical activity) is a challenge to treat despite recent advances. One factor contributing to this challenge is our limited ability to synthesise/meta-analyse research findings, which is further compounded by a lack of valid outcome measures. We determined the core outcome domains agains...
Article
Full-text available
Background Treatment with ultrasound and colour Doppler–guided minimally invasive Achilles tendon scraping and plantaris tendon removal has shown promising short-term results in patients with chronic painful midportion Achilles tendinopathy. Methods In a follow-up study, 182 consecutive patients (241 tendons) who had undergone Achilles tendon scra...
Article
Plantaris tendon is implicated in some cases of load-resistant Achilles tendinopathy. The tendon courses close to the medial Achilles tendon mid-portion prior to insertion onto the medial calcaneus, although there is variation in course and insertion. Clinical suspicion of plantaris involvement includes persistent medial Achilles pain unresponsive...
Article
Full-text available
The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting inj...
Article
Full-text available
Objectives Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon. Design and setting Prospective case series study at one centre. Par...
Article
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This report concerns the unusual case of a 48-year old, world-class triathlete who has won 11 ironman competitions. She has reached the top level of international endurance sport in spite of being diagnosed with cystic fibrosis. This patient presented with Achilles pain and severe bony pathology at her left Achilles insertion. Traditionally this co...
Article
Background: The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and has been traditionally managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been form...
Article
Metabolic factors such as cholesterol appear to play an important role in the development of Achilles tendinopathy. There is, however, no morphologic proof explaining the link between high cholesterol and tendinopathy. As apolipoprotein A1 (Apo-A1) is essential for reverse cholesterol transport, it may be related to cholesterol overload in tendon....
Article
Full-text available
Background The peritendinous connective tissues can have importance in chronic tendon pain. Recently cytokine TNF-α has been suggested to be involved in tendinopathic processes. It is not known how TNF-α and its receptors TNFR1 and TNFR2 are expressed in peritendinous tissues. Methods The objective for this study was to immunohistochemically evalu...
Article
Background Non-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups. Aims To study the diagnose...
Article
Full-text available
Background Tennis elbow is difficult to treat. The results of surgical treatments are not convincing. Treatment studies on Achilles and patellar tendinopathy targeting the richly innervated and vascularized soft tissues outside the tendon have shown promising outcomes. The innervation patterns in the fibrous/fatty tissues superficially to the elbow...
Article
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Previous in vitro studies on human tendon cells (tenocytes) have demonstrated that the exogenous administration of substance P (SP) and acetylcholine (ACh) independently result in tenocyte proliferation, which is a prominent feature of tendinosis. Interestingly, the possible link between SP and ACh has not yet been explored in human tenocytes. Rece...
Article
The plantaris tendon can contribute to persistent pain in patients who present with what seems at first glance to be mid-portion Achilles tendinopathy.1–8 Clinicians should consider the plantaris tendon when evaluating painful Achilles tendon conditions, particularly those that are not responding to treatment. Below are typical findings related to...
Article
Background Differential motion between the plantaris and Achilles tendons has been hypothesized to contribute to pain in some patients presenting with Achilles tendinopathy. However, objective evidence of differential Achilles-plantaris motion is currently lacking from the literature. Objective To determine whether differential, multidirectional m...
Article
In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical excision of the plantaris tendon has been reported to be curative in patients who have not derived benefit followi...
Article
Background/aim: In a condition of pain in the Achilles tendon insertion there are multiple structures involved, such as the Achilles tendon itself, the retrocalcaneal bursa and a bony protrusion at the calcaneal tuberosity called Haglund's deformity. The innervation patterns of these structures are scarcely described, and the subcutaneous calcanea...
Article
Full-text available
Background: There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy. Aim: This study...
Chapter
Chronic painful tendinopathy is common in elite and recreational athletes and in sedentary subjects; all may have to stop or decrease their level of physical activity [1, 2]. Midportion Achilles tendinopathy and for the younger and heavy loading population also patellar tendinopathy are problematic injuries. However, recent research on innervation...
Article
Full-text available
Background: Achilles tendinopathy is a painful musculoskeletal condition that is common among athletes, and which limits training capacity and competitive performance. The lack of biomarkers for tendinopathy limits research into risk factors and also the evaluation of new treatments. Cytokines and growth factors involved in regulating the response...
Article
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Background The purpose of this investigation was to evaluate if clinical assessment, Ultrasound + Colour Doppler (US + CD) and Ultrasound Tissue Characterisation (UTC) can be useful in detecting plantaris tendon involvement in patients with midportion Achilles tendinopathy. Methods Twenty-three tendons in 18 patients (14 men, mean age: 37 years an...
Article
Full-text available
Tendinopathies are pathological conditions of tissue remodelling occurring in the major tendons of the body, accompanied by excessive nociceptive signalling. Tendinopathies have been shown to exhibit an increase in the number of mast cells, which are capable of releasing histamine, tryptase and other substances upon activation, which may play a rol...
Article
Full-text available
The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in th...
Chapter
Full-text available
Regenerative injection therapy (RIT), also known as prolotherapy or sclerotherapy, is a treatment for chronic musculoskeletal pain caused by connective tissue diathesis utilizing chemical or biologic substances. Steroidal and nonsteroidal anti-inflammatory medications are useful in degenerative disease processes with concomitant inflammatory change...
Article
Full-text available
The plantaris tendon is increasingly recognised as an important factor in midportion Achilles tendinopathy. Its innervation pattern is completely unknown. Plantaris tendons (n=56) and associated peritendinous tissue from 46 patients with midportion Achilles tendinopathy and where the plantaris tendon was closely related to the Achilles tendon were...
Article
Human tendon cells have the capacity for acetylcholine (ACh) production. It is not known if the tendon cells also have the potential for ACh breakdown, nor if they show expression of the nicotinic acetylcholine receptor AChRα7 (α7nAChR). Therefore, tendon tissue specimens from patients with midportion Achilles tendinopathy/tendinosis and from norma...
Article
Full-text available
Objectives The plantaris tendon has recently been described as a possible important factor in midportion Achilles tendinopathy. Ultrasound tissue characterisation (UTC) is a method to study tendon structure (matrix integrity). The effect of plantaris tendon removal on Achilles tendon structure was studied using UTC. Design and setting Prospective c...
Article
Full-text available
Objectives The plantaris tendon has recently been described as a possible important factor in midportion Achilles tendinopathy. Ultrasound tissue characterisation (UTC) is a method to study tendon structure (matrix integrity). The effect of plantaris tendon removal on Achilles tendon structure was studied using UTC. Design and setting Prospective...
Article
Full-text available
Background: Linoleic acid-derived oxidation products are found in experimental pain models. However, little is known about the levels of such oxylipins in human pain. In consequence, in the present study, we have undertaken a lipidomic profiling of oxylipins in blood serum from patients with Achilles tendinopathy and controls. Methodology/princip...
Article
Introduction We in our research group have previously noticed that the tenocytes of human tendons exhibit reaction for the enzyme choline acetyltransferase (ChAT).1,4 That was especially the fact for tenocytes of tendinopathic tendons. The findings suggest that the cells can produce the signal substance acetylcholine (ACh). This is in line with fin...
Conference Paper
Introduction: Tennis elbow/extensor carpi radialis brevis (ECRB) tendinopathy is well known to be difficult to treat. There is no concensus about treatment. Material and methods: Five patients (3 females and 2 males, mean age 43 years) with a long duration (12–48 months) of pain symptoms related to Tennis elbow were in local anaesthesia treated wi...
Conference Paper
Full-text available
Introduction Recent studies have highlighted the plantaris tendon and its possible involvement in midportion Achilles tendinopathy. In several patients an enlarged/thickened plantaris tendon has been found to lay in close relationship to the Achilles tendon.1 Excision has shown to lead to good clinical outcome.4 Histological investigations reported...
Conference Paper
Introduction Recent cadaveric [Van Sterenberg et al. 2011], histological [Spang et al. 2013], and clinical/surgical (Alfredson, 2011) studies lend support to the theory that the plantaris tendon may be involved in the aetiology and/or pathogenesis of midportion Achilles tendinopathy. Unfortunately, it is not easy to detect a plantaris tendon, espec...
Article
Introduction The plantaris tendon is increasing recognised as an important factor in midportion Achilles tendinoapathy. Recent cadveric1 and histological studies2 lend support to the theory that the plantaris tendon may be involved in the aetiology and/or the pathogenesis of midportion Achilles tendinopathy. In addition, a recent innovative surgica...
Article
Introduction For many years midportion Achilles tendinopathy was known to be difficult to treat. Recent advances using immunohistochemical analyses of tissue specimens have clarified the neural patterns in this condition, and new treatment approaches focusing on the blood vessel and nerve rich ventral side of the Achilles have shown good clinical r...
Article
Ausgebremst: Manchmal erweist sich das, was uns zuerst als „schlecht“ erscheint, im Nachhinein als gut. So erging es auch Professor Alfredson, als er zahneknirschend feststellen musste, dass seine Achillessehne nicht operiert werden sollte. Er versuchte alles und kampfte – bis er feststellte, dass er eine neue Therapiemethode gefunden hatte. Hier e...
Article
Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic finding...
Conference Paper
Full-text available
Altered expression of several cytokines and growth factors has been shown in biopsies of tendinopathy tissue. Biopsy studies are however challenged by capacity to obtain i) healthy tissue for comparison, ii) multiple samples to monitor cytokine dynamics, and iii) tissue from recent onset tendinopathy. An alternative is to study cytokines in blood s...
Article
Introduction Treatment of chronic painful midportion Achilles tendinopathy is known to be difficult. Multiple non-tendon-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, it has become increasingly popular to try injections of PRP and autologous blood, and intratendinous open surgery is indicated finally....
Chapter
Treatment with ultrasound and Doppler-guided arthroscopic shaving of the region with vessels and nerves outside the dorsal tendon has shown promising clinical results in patients with proximal patellar tendinopathy/Jumper´s knee. The results concerning only a limited patient material has been published in a scientific paper. Results on larger mater...
Article
Background The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neove...
Chapter
Full-text available
Regenerative injection therapy (RIT), also known as prolotherapy or sclerotherapy, is a treatment for chronic musculoskeletal pain caused by connective tissue diathesis utilizing chemical or biologic substances. Steroidal and nonsteroidal anti-inflammatory medications are useful in degenerative disease processes with concomitant inflammatory change...
Article
Treatment of midportion Achilles tendinopathy has been known to be difficult. Recent ultrasound(US) and Doppler(CD) findings (high blood flow outside ventral tendon), together with results of immunohistochemical analyses (marked presence of blood vessels accompanied by nerve fascicles in the ventral peritendinous tissue) have led to new treatment a...