Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

For Online Access

Best Paper Award Selection - Editorial Board Site

2000, Volume12

Issue 2

104 pages

Issue price - $163.00

Hakan Alfredson
Sports Medicine Unit, Department of Surgical and Perioperative Science, University Hospital of Umea, S-901 87 Umea, Sweden

Ronny Lorentzon
Sports Medicine Unit, Department of Surgical and Perioperative Science, and Department of Musculoskeletal Research National Institute for Working Life, University Hospital of Umea, S-901 87 Umea, Sweden

Chronic achilles tendinosis is characterized by a tendon pathology showing increased amounts of inter-fibrillar GAGs (glycosaminoglycans) and changes in the collagen fiber structure and arrangement, but there are no inflammatory cells. Recently investigation with microdialysis technique confirmed the absence of inflammation. The etiology and pathogenesis are unknown. It is a condition considered to be associated with overuse, however, it is also seen in patients with a sedentary lifestyle. The occurrence of Achilles tendinosis is most often, but not always, associated with pain during loading of the Achilles tendon. It is considered a troublesome injury to treat, and it has been stated that, in general, in about 25% of patients nonsurgical treatment is not successful. Most commonly nonsurgical treatment includes a combination of rest, NSAIDs, correction of malalignements, stretching, and strengthening exercises. However, the scientific evidence supporting the use of most proposed treatment regimens is sparse. Surgical treatment most often show very good short-term results, but there are signs of a possible deterioration with time in the few studies with long-term follow ups. After surgical treatment, it has been shown to take a long time to recover calf-muscle strength, and also a prolonged progressive calcaneal bone loss has been shown on the operated side up to 1 year after operation. In a recent prospective study on patients with tendinosis located in the midportion of the Achilles tendon, nonsurgical treatment with heavy-load eccentric calf-muscle training showed very promising results and may possibly minimize the need for surgical treatment of tendinosis at that level of the tendon. However, further research in order to clarify the pain mechanism and the role of neuropeptides, opioids, and other neurotransmitters is needed.

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