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Chronic Achilles Tendinosis

Recommendations for Treatment and Prevention

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Abstract

Chronic Achilles tendinosis is a condition with an unknown aetiology and pathogenesis that is often, but not always, associated with pain during loading of the Achilles tendon. Histologically, there are no inflammatory cells, but increased amounts of interfibrillar glycosaminoglycans and changes in the collagen fibre structure and arrangement are seen. In situ microdialysis has confirmed the absence of inflammation. It is a condition that is most often seen among recreational male runners aged between 35 and 45 years, and it is most often considered to be associated with overuse. However, this condition is also seen in patients with a sedentary lifestyle.

Chronic Achilles tendinosis is considered a troublesome injury to treat. Nonsurgical treatment most often includes a combination of rest, NSAIDs, correction of malalignments, and stretching and strengthening exercises, but there is sparse scientific evidence supporting the use of most proposed treatment regimens. It has been stated that, in general, nonsurgical treatment is not successful and surgical treatment is required in about 25% of patients. However, in a recent prospective study, treatment with heavy load eccentric calf muscle training showed very promising results and may possibly reduce the need for surgical treatment of tendinosis located in the midportion of the Achilles tendon.

The short term results after surgical treatment are frequently very good, but in the few studies with long term follow-up there are signs of a possible deterioration with time. Calf muscle strength takes a long time to recover and, furthermore, a prolonged progressive calcaneal bone loss has been shown on the operated side up to 1 year after surgical treatment.

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Authors and Affiliations

  1. Department of Surgical and Perioperative Science, Umeå University, S-90187, Umeå, Sweden

    Håkan Alfredson

  2. Department of Musculoskeletal Research, National Institute for Working Life, Umeå, Sweden

    Ronny Lorentzon

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  1. Håkan Alfredson
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  2. Ronny Lorentzon
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Correspondence to Håkan Alfredson.

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Alfredson, H., Lorentzon, R. Chronic Achilles Tendinosis. Sports Med 29, 135–146 (2000). https://doi.org/10.2165/00007256-200029020-00005

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