Skip to main content

Advertisement

SpringerLink
Log in

Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study is to explain the cause–effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis.

Methods

Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected.

Results

An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances.

Conclusions

Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk–benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Alfredson H, Cook J (2007) A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med 41:211–216

    Article  PubMed Central  PubMed  Google Scholar 

  2. Andersson G, Forsgren S, Scott A et al (2011) Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy: contralateral effects suggest the involvement of central neuronal mechanisms. Br J Sports Med 45:399–406

    Article  PubMed  Google Scholar 

  3. Astrom M (1998) Partial rupture in chronic Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand 69:404–407

    Article  CAS  PubMed  Google Scholar 

  4. Balasubramaniam P, Prathap K (1972) The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg Br 54:729–734

    CAS  PubMed  Google Scholar 

  5. Barfred T (1973) Achilles tendon rupture. Aetiology and pathogenesis of subcutaneous rupture assessed on the basis of the literature and rupture experiments on rats. Acta Orthop Scand Suppl 3:126

    Google Scholar 

  6. Bedi SS, Ellis W (1970) Spontaneous rupture of the calcaneal tendon in rheumatoid arthritis after local steroid injection. Ann Rheum Dis 29:494–495

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Bjur D, Alfredson H, Forsgren S (2009) Presence of the neuropeptide Y1 receptor in tenocytes and blood vessel walls in the human Achilles tendon. Br J Sports Med 43:1136–1142

    Article  CAS  PubMed  Google Scholar 

  8. Cummins EJ, Anson BJ et al (1946) The structure of the calcaneal tendon (of Achilles) in relation to orthopedic surgery, with additional observations on the plantaris muscle. Surg Gynecol Obstet 83:107–116

    CAS  PubMed  Google Scholar 

  9. DeVries JG, Summerhays B, Guehlstorf DW (2009) Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg 48:447–451

    Article  PubMed  Google Scholar 

  10. Doral MN, Alam M, Bozkurt M et al (2010) Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 18:638–643

    Article  PubMed  Google Scholar 

  11. Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O (1997) Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis 56:59–63

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Ford LT, DeBender J (1979) Tendon rupture after local steroid injection. South Med J 72:827–830

    Article  CAS  PubMed  Google Scholar 

  13. Fredberg U (1997) Local corticosteroid injection in sport: review of literature and guidelines for treatment. Scand J Med Sci Sports 7:131–139

    Article  CAS  PubMed  Google Scholar 

  14. Gisslen K, Alfredson H (2005) Neovascularisation and pain in jumper’s knee: a prospective clinical and sonographic study in elite junior volleyball players. Br J Sports Med 39:423–428

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Halpern AA, Horowitz BG, Nagel DA (1977) Tendon ruptures associated with corticosteroid therapy. West J Med 127:378–382

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Haraldsson BT, Aagaard P, Crafoord-Larsen D, Kjaer M, Magnusson SP (2009) Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat-tail tendon. Scand J Med Sci Sports 19:621–626

    Article  CAS  PubMed  Google Scholar 

  17. Hugate R, Pennypacker J, Saunders M, Juliano P (2004) The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons. J Bone Joint Surg Am 86:794–801

    PubMed  Google Scholar 

  18. Jhingan S, Perry M, O’Driscoll G, Lewin C, Teatino R, Malliaras P, Maffulli N, Morrissey D (2011) Thicker Achilles tendons are a risk factor to develop Achilles tendinopathy in elite professional soccer players. Muscle Ligament Tendon J I:51–56

    Google Scholar 

  19. Kaalund S, Lass P, Hogsaa B, Nohr M (1989) Achilles tendon rupture in badminton. Br J Sports Med 23:102–104

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Kachlik D, Baca V, Cepelik M et al (2008) Clinical anatomy of the retrocalcaneal bursa. Surg Radiol Anat 30:347–353

    Article  CAS  PubMed  Google Scholar 

  21. Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525

    CAS  PubMed  Google Scholar 

  22. Kapetanos G (1982) The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Clin Orthop Relat Res 1982:170–179

    Google Scholar 

  23. Kleinman M, Gross AE (1983) Achilles tendon rupture following steroid injection. Report of three cases. J Bone Joint Surg Am 65:1345–1347

    CAS  PubMed  Google Scholar 

  24. Koenig MJ, Torp-Pedersen S, Qvistgaard E, Terslev L, Bliddal H (2004) Preliminary results of colour Doppler-guided intratendinous glucocorticoid injection for Achilles tendonitis in five patients. Scand J Med Sci Sports 14:100–106

    Article  CAS  PubMed  Google Scholar 

  25. Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh EC (2007) Magnetic resonance imaging findings of injuries to the calf muscle complex. Skelet Radiol 36:921–927

    Article  Google Scholar 

  26. Lee HB (1957) Avulsion and rupture of the tendo calcaneus after injection of hydrocortisone. Br Med J 2:395

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Loppini M, Maffulli N (2012) Conservative management of tendinopathy: an evidence-based approach. Muscle Ligament Tendon Journal 133–136

  28. Mahler F, Fritschy D (1992) Partial and complete ruptures of the Achilles tendon and local corticosteroid injections. Br J Sports Med 26:7–14

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Mazzone MF, McCue T (2002) Common conditions of the Achilles tendon. Am Fam Physician 65:1805–1810

    PubMed  Google Scholar 

  30. Notarnicola A, Maccagnano G, Di Leo M, Tafuri S, Moretti B. Overload and neovascularization of Achilles tendons in young artistic and rhythmic gymnasts compared with controls: an observational study. Musculoskelet Surg (In Press)

  31. Noyes FR, Grood ES, Nussbaum NS, Cooper SM (1977) Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees. Clin Orthop Relat Res 123:197–209

    CAS  PubMed  Google Scholar 

  32. Ohberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177

    Article  PubMed Central  PubMed  Google Scholar 

  33. Paavola M, Kannus P, Jarvinen TA, Jarvinen TL, Jozsa L, Jarvinen M (2002) Treatment of tendon disorders. Is there a role for corticosteroid injection? Foot Ankle Clin 7:501–513

    Article  PubMed  Google Scholar 

  34. Read MT (1999) Safe relief of rest pain that eases with activity in achillodynia by intrabursal or peritendinous steroid injection: the rupture rate was not increased by these steroid injections. Br J Sports Med 33:134–135

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Read MT, Motto SG (1992) Tendo Achillis pain: steroids and outcome. Br J Sports Med 26:15–21

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Robert S (2008) Management of partial tears of the gastro-soleus complex. Clin Sports Med 27:219–229

    Article  Google Scholar 

  37. Savarese E, Bisicchia S, Amendola A (2010) Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg 94:81–88

    Article  PubMed  Google Scholar 

  38. Sofka CM, Adler RS, Positano R, Pavlov H, Luchs JS (2006) Haglund’s syndrome: diagnosis and treatment using sonography. HSS J 2:27–29

    Article  PubMed Central  PubMed  Google Scholar 

  39. Speed CA (2001) Fortnightly review: corticosteroid injections in tendon lesions. BMJ 323:382–386

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Szaro P, Witkowski G, Smigielski R, Krajewski P, Ciszek B (2009) Fascicles of the adult human Achilles tendon—an anatomical study. Ann Anat 191:586–593

    Article  PubMed  Google Scholar 

  41. Thevendran G, Sarraf K, Patel N, Sadri A, Rosenfeld P (2013) The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg 97:9–20

    Article  CAS  PubMed  Google Scholar 

  42. Unverferth LJ, Olix ML (1973) The effect of local steroid injections on tendon. J Sports Med 1:31–37

    Article  CAS  PubMed  Google Scholar 

  43. Valente M, Crucil M, Alecci V, Frezza G (2012) Minimally invasive repair of acute Achilles tendon ruptures with Achillon device. Musculoskelet Surg 95:35–39

    Article  Google Scholar 

  44. Valente M, Mancuso F, Alecci V. Isolated rupture of biceps femoris tendon. Musculoskelet Surg (In Press)

  45. Zingas C, Failla JM, Van Holsbeeck M (1998) Injection accuracy and clinical relief of de Quervain’s tendinitis. J Hand Surg Am 23:89–96

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

All the authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. High Performance Center (CAR de Sant Cugat Consorci Sanitari de Terrassa), Barcelona, Spain

    A. Turmo-Garuz & L. Til

  2. Medical Service, Barcelona Football Club, Barcelona, Spain

    G. Rodas & L. Til

  3. Consell Català de l’Esport, Barcelona, Spain

    R. Balius

  4. Department of Professional Sports Medicine, School of Medicine, University of Barcelona, Barcelona, Spain

    A. Turmo-Garuz

  5. Unit of Human Anatomy and Embryology, Department of Experimental Pathology and Therapeutics, Bellvitge Campus, University of Barcelona, Barcelona, Spain

    M. Miguel-Perez & C. Pedret

  6. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy

    A. Del Buono

  7. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    N. Maffulli

Authors
  1. A. Turmo-Garuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Rodas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Balius
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Til
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Miguel-Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Pedret
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Del Buono
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N. Maffulli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Maffulli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turmo-Garuz, A., Rodas, G., Balius, R. et al. Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?. Musculoskelet Surg 98, 121–126 (2014). https://doi.org/10.1007/s12306-013-0305-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-013-0305-9

Keywords

Search

Navigation