Management of Achilles and patellar tendinopathy: what we know, what we can do
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(2020) 13:59
REVIEW
Open Access
Management of Achilles and patellar tendinopathy: what we know, what we can do Rocco Aicale1,2, Antonio Oliviero1,2 and Nicola Maffulli1,2,3,4*
Abstract Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions. Keywords: Tendinopathies, Achilles Tendinopathy, Patellar tendinopathy, Tendon, Graft, Arthroscopy, Tenotomy
Background In the United Kingdom, soft tissues disorders have a prevalence of 18 cases for 1000 individuals, and account for 40% of new rheumatology consultations [1]. Tendons can undergo degenerative and traumatic processes. The most vulnerable tendons are those of the rotator cuff, the long head of the biceps, the wrist extensors and flexors, the adductors, the posterior tibial tendon, the patellar tendon and the Achilles tendon, with tendinopathy commonly secondary to overload [2], though one third of patients with these pathologies do not practice regular physical activity [3].
* Correspondence: [email protected] 1 Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy 2 Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy Full list of author information is available at the end of the article
Tendon injuries can be acute or chronic and caused by intrinsic (age [4], body structure [5], nutrition [6], metabolic diseases [7, 8], genetics [9, 10]) or extrinsic (excessive [2, 11], fatigue and improper [11] loading disuse [12] and external damage [13, 14]) factors, alone or in combination [1]. In acute trauma, extrinsic factors predominate, whilst in chronic cases intrinsic factors also play a role. These factors are associated with the onset of overload pathology of tendons, though there is not a specific cause - effect relationship Table 1. Microscopic examination of abnormal tendon tissues normally shows a non-inflammatory process [15] with disordered arrangement of collagen fibres, incre
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