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Clinical presentation and surgical management of chronic Achilles tendon disorders: a retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. ISEH, UCLH, London, UK; Pure Sports Medicine Clinic, London, UK.
Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Dr Alfen, Orthopedic Spine Center, 97080 Würzburg, Germany.
2018 (English)In: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 24, no 6, p. 490-494Article in journal (Refereed) Published
Abstract [en]

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 diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders.

Material and methods: One surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment - Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database.

Results: Clinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications.

Conclusions: Patients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent. 

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 24, no 6, p. 490-494
Keywords [en]
Tendinopathy, Midportion, Tendinosis, Partial rupture, Plantaris, Insertional
National Category
Sport and Fitness Sciences Surgery
Identifiers
URN: urn:nbn:se:umu:diva-154030DOI: 10.1016/j.fas.2017.05.011ISI: 000451098700005PubMedID: 29409190OAI: oai:DiVA.org:umu-154030DiVA, id: diva2:1272852
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2018-12-20Bibliographically approved

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Alfredson, HåkanSpang, Christoph

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Sports medicineRehabilitation MedicineDepartment of Integrative Medical Biology (IMB)
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