Endoscopic SpeedBridge Procedure for the Treatment for Insertional Achilles Tendinopathy: The Snake Technique

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

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Contralateral mechanical hyperalgesia and altered pain modulation in men who have unilateral insertional Achilles tendinopathy: A cross-sectional study

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2021.102353 ◽

2021 ◽

Vol 52 ◽

pp. 102353

Author(s):

Patrick Vallance ◽

Liam Crowley ◽

Bill Vicenzino ◽

Peter Malliaras

Keyword(s):

Cross Sectional Study ◽

Achilles Tendinopathy ◽

Pain Modulation ◽

Mechanical Hyperalgesia ◽

Sectional Study ◽

Cross Sectional ◽

Insertional Achilles Tendinopathy

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Forefoot and rearfoot contributions to the lunge position in individuals with and without insertional Achilles tendinopathy

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2016.05.007 ◽

2016 ◽

Vol 36 ◽

pp. 40-45 ◽

Cited By ~ 2

Author(s):

R.L. Chimenti ◽

A. Forenza ◽

E. Previte ◽

J. Tome ◽

D.A. Nawoczenski

Keyword(s):

Achilles Tendinopathy ◽

Insertional Achilles Tendinopathy

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Dorsal closing wedge calcaneal osteotomy for the treatment of Insertional Achilles Tendinopathy: A technical tip to optimize its results and reduce complications

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.12.004 ◽

2018 ◽

Vol 24 (2) ◽

pp. 115-118 ◽

Cited By ~ 9

Author(s):

D. Georgiannos ◽

D. Kitridis ◽

I. Bisbinas

Keyword(s):

Achilles Tendinopathy ◽

Closing Wedge ◽

Calcaneal Osteotomy ◽

Insertional Achilles Tendinopathy

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Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients

British Journal of Pain ◽

10.1177/2049463718800352 ◽

2018 ◽

Vol 13 (3) ◽

pp. 137-144

Author(s):

Patrick C Wheeler

Keyword(s):

Lower Limb ◽

Plantar Fasciitis ◽

Pain Syndrome ◽

Achilles Tendinopathy ◽

Control Group ◽

Greater Trochanteric Pain Syndrome ◽

Duration Of Symptoms ◽

Central Sensitisation ◽

Clinical Records ◽

Insertional Achilles Tendinopathy

Introduction: To identify the possible prevalence of ‘central sensitisation’, in patients with chronic recalcitrant lower limb tendinopathy conditions, with the Central Sensitisation Inventory (CSI) questionnaire. Methods: Patients with chronic lower limb tendinopathy conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified from clinical records. As part of routine care, self-reported numerical markers of pain, global function (using the EuroQol-5D (EQ-5D) questionnaire) and the CSI score to investigate the possibility of central sensitisation were completed. Results: A total of 312 suitable patients with chronic lower limb tendinopathy and similar conditions were identified, who had completed a CSI questionnaire. Of these, 108 presented with greater trochanteric pain syndrome, 12 with patella tendinopathy, 33 with non-insertional Achilles tendinopathy, 48 with insertional Achilles tendinopathy and 110 with plantar fasciitis. A total of 66% of the patients were female, the median age was 54.9 years and the median duration of symptoms was 24 months. There was a median CSI score of 25%, with statistically significant differences noted between the different conditions studied. Overall, 20% of patients scored above a threshold of 40% on CSI questionnaire, indicating that central sensitisation was possible. Greater trochanteric pain syndrome and plantar fasciitis had the highest proportions in the conditions studied. Weak correlations were found between CSI and other pain scores studied. Conclusion: The CSI questionnaire may identify up to a quarter of patients with some chronic lower limb tendinopathy and associated conditions as being more likely to have central sensitisation, and these proportions differed between conditions. The clinical significance of this is unclear, but worth further study to see if/how this may relate to treatment outcomes. These are results from a single hospital clinic dealing with patients with chronic tendinopathy, and comparison with a control group is currently lacking. However, on the information presented here, the concept of central sensitisation should be considered in patients being treated for chronic tendinopathy.

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The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

Foot & Ankle Specialist ◽

10.1177/19386400211033693 ◽

2021 ◽

pp. 193864002110336

Author(s):

LT Thomas J. Kelsey ◽

LT Kyle W. Mombell ◽

CDR Todd A. Fellars

Keyword(s):

Achilles Tendon ◽

Suture Anchor ◽

Maximum Load ◽

Achilles Tendinopathy ◽

Catastrophic Failure ◽

Double Row ◽

Average Load ◽

Load To Failure ◽

Insertional Achilles Tendinopathy ◽

Repair Techniques

Background In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Methods Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. Results The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure ( P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). Conclusion This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

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