Basic Science and Clinical Aspects of Achilles Tendinopathy

Department of Trauma and Orthopaedic Surgery, University Hospital Wales, Heath Park Cardiff, UK.
Sports medicine and arthroscopy review (Impact Factor: 1.68). 10/2009; 17(3):190-7. DOI: 10.1097/JSA.0b013e3181b37eb7
Source: PubMed


Achilles tendinopathy is one of the common disorders seen in athletes. It is a degenerative rather than an inflammatory, condition. There is a lifetime risk of 52% in former elite male distance runners. This condition is difficult to manage and up to 29% of Achilles tendinopathy patients may require surgery. It often results in chronic pain and discomfort along with failure to regain full function. It can be complicated by partial tears or complete rupture causing long-term burden on healthcare system and making treatment quite difficult.

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Available from: Nicola Maffulli, Apr 03, 2014
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    • "It is expressed that tendon ruptures occur more in males due to the fact that calcaneal tendon is of a rigid character in them (Doral et al., 2010). Besides, it is stated in studies that achilles tendinopathy occurs commonly in athletes (Zafar et al., 2009). It is pointed out that there is a 52% of risk for tendinopathy, particularly in the long-distance male runners throughout their lives (Zafar et al.). "
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    ABSTRACT: It was aimed that the morphometric development of calcaneal tendon and the structures building it up in human fetuses during the fetal period be anatomically studied and that its clinical importance be evaluated. The study comprised a total of 102 fetus legs (51 human fetuses: 26 male and 25 female) whose ages varied between 15-40 gestational week, without external pathology or anomaly. The fetuses were divided in groups according to gestational weeks, trimesters and months. In the wake of the general external measurements of fetuses, leg dissection was performed. Afterwards, the morphometric parameters of gastrocnemius muscle, soleus muscle and calcaneal tendon were measured. The averages and the standard deviations of the measured parameters were determined according to gestational weeks, trimesters and months. There was a significant correlation between the measured parameters and the gestational age (p<0.001). There was no difference between sexes in terms of parameters (p>0.005). All the obtained results were discussed by making a comparison between them and the previous studies made. We are of the opinion that the data obtained in our study will be of use to the involved clinicians in the evaluation of the development of calcaneal tendon and the structures constituting it during the fetal period and in clinical studies and applications as well. © 2015, International Journal of Morphology. All rights reserved.
    Preview · Article · Sep 2015 · International Journal of Morphology
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    • "In the knee area a typical formation of patellofemoral syndrome known as " runner's knee " or patellar tendinitis known as " jumper's knee " and some forms of bursitis could occur. In the shank and foot area we could find a presence of medial tibial stress syndrome and frequent injuries of Achilles tendon (Alfredson, 2003; Järvinen, Kannus, Maffulli, & Khan, 2005; Maffulli, Sharma, & Luscombe, 2004; Zafar, Mahmood, & Maffulli, 2009). For example de Vos et al. (2010) found out that up to 52% of endurance runners hurt their Achilles tendon sometime during their career. "
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    • "Despite some advancements in the management of acute and chronic tendinopathies, several aspects related to the pathophysiology of human tendons remain largely unclear [1]–[3]. Tendon cells, residing between fibril components mainly represented by collagens and proteoglycans, synthetize extracellular matrix (ECM) [4]–[6]. "
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    ABSTRACT: In vitro models of human tenocytes derived from healthy as well as from ruptured tendons were established, characterized and used at very early passage (P1) to evaluate the effects of Extracorporeal Shock Wave Treatment (ESWT). The molecular analysis of traditional tenocytic markers, including Scleraxis (Scx), Tenomodulin (Tnm), Tenascin-C (Tn-C) and Type I and III Collagens (Col I and Col III), permitted us to detect in our samples the simultaneous expression of all these genes and allowed us to compare their levels of expression in relationship to the source of the cells and treatments. In untreated conditions, higher molecular levels of Scx and Col I in tenocytes from pathological compared to healthy samples have been detected, suggesting - in the cells from injured tendon - the natural trigger of an early differentiation and repairing program, which depends by Scx and requires an increase in collagen expression. When ESWT (at the dose of 0.14 mJ/mm(2)) was applied to cultured tenocytes explanted from injured source, Scx and Col I were significantly diminished compared to healthy counterpart, indicating that such natural trigger maybe delayed by the treatment, in order to promote cellular repair. Herein, we show for the first time that ESWT enhances in vitro functional activities of ruptured tendon-derived tenocytes, such as proliferation and migration, which could probably contributes to tendon healing in vivo.
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