Shockwave Therapy Associated With Eccentric Strengthening for Achilles Insertional Tendinopathy: A Prospective Study

2019 ◽  
Vol 12 (6) ◽  
pp. 540-545 ◽  
Author(s):  
Nacime Salomão Barbachan Mansur ◽  
Tiago Baumfeld ◽  
Fernando Villalon ◽  
Bruno Takeshi Aoyama ◽  
Fabio Teruo Matsunaga ◽  
...  
Keyword(s):  
Prospective Study ◽  
Treatment Protocol ◽  
Achilles Tendinopathy ◽  
Shockwave Therapy ◽  
Insertional Tendinopathy ◽  
American Orthopaedic ◽  
Global Pain ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Background. The usual initial treatment for insertional Achilles tendinopathy is nonsurgical. Yet there is no standard conservative treatment for Achilles insertional tendinopathy. Shockwave therapy (SWT) has become a reliable option for the management of this illness over the past years. The aim of this study is to report the effectiveness of low-energy SWT associated with an eccentric strengthening protocol in 19 consecutive patients. Methods. This is a prospective study with 19 patients aged between 26 and 72 years diagnosed with insertional Achilles tendinopathy. The protocol consisted of SWT associated with eccentric exercises for 12 weeks. All patients were evaluated on the first day and after 24 weeks (final follow-up) with the Victorian Institute of Sports Assessment–Achilles (VISA-A) score, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, and by algometry. At the last follow-up, patients were also assessed for adherence to the protocol, complications and final outcome (in their perception as success or fail). Results and Conclusion. Fifteen (79%) patients were fully adherent to the Alfredson protocol, and 13 (68%) patients considered the treatment protocol successful. At the last evaluation, patients demanded higher pressure on calcaneus to trigger pain (algometry 1), reported less pain when the algometer was applied with 3 kg (algometry 2), had less global pain (VAS), and had higher AOFAS and VISA-A scores. This study evidences that eccentric loading associated with SWT can dramatically improve patients’ symptoms. We can conclude that eccentric loading associated with SWT is an effective treatment for Achilles insertional tendinopathy. Levels of Evidence: Therapeutic, Level III: Prospective cohort

scholarly journals PO 18076 - Shockwave therapy associated with eccentric strengthening for Achilles insertional tendinopathy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 10S
Author(s):  
Tiago Soares Baumfeld ◽  
Nacime Salomão Barbachan Mansur ◽  
Fernando Villalon ◽  
Paulo Dos Santos ◽  
Bruno Shiefer ◽  
...  
Keyword(s):  
Achilles Tendinopathy ◽  
Foot And Ankle ◽  
Eccentric Training ◽  
Shockwave Therapy ◽  
Insertional Tendinopathy ◽  
Pain Visual Analog Scale ◽  
Global Pain ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Introduction: Conservative treatment for insertional Achilles tendinopathy (IAT) has failed to produce encouraging results in recent years. Shockwave therapy (SWT) has become a reliable option for the management of this disease in recent years. The objective of this study is to report the effectiveness of low-energy SWT combined with an eccentric strengthening protocol in 19 consecutive patients. Methods: This is a prospective study of 19 patients diagnosed with IAT. The protocol consisted of SWT combined with eccentric training for 12 weeks. All patients were evaluated on the first day and after 24 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) score, the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and algometry. The patients were also evaluated for compliance with the protocol, complications and final outcome. Results: All patients completed the study without complications. In total, 15 (79%) patients fully complied with the Alfredson protocol, and 13 (68%) considered the treatment successful. At the final evaluation, the patients required more pressure on the calcaneus to trigger pain (Algometry 1), reported less pain when applying the algometer with 3 kg of pressure (Algometry 2) and had less global pain (VAS) and higher AOFAS and VISA-A scores. All differences were significant. Conclusion: Eccentric training combined with SWT is an effective treatment for IAT. Further placebo-controlled studies with a longer follow-up are necessary to support this statement.

scholarly journals Treatment of insertional Achilles tendinopathy with ultrasound-guided intrabursal retrocalcaneal hyaluronic acid injection - a prospective study

2020 ◽  
Author(s):  
Omer Slevin ◽  
David Segal ◽  
Nissim Ohana ◽  
Eugene Kots ◽  
Viktor Feldman ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Univariate Analysis ◽  
Achilles Tendinopathy ◽  
Ultrasound Guided ◽  
Hyaluronic Acid Injection ◽  
Functional Scores ◽  
Rank 2 ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Abstract BackgroundInsertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy involving fibrocartilage changes that resemble osteoarthritic changes in articular cartilage. Thus, our primary goal was to evaluate the effect of hyaluronic acid (HA) injections on IAT. MethodsFifteen IAT ankles (14 patients) were treated with three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of hylan G-F 20 (Synvisc®). Patients answered the "Victorian Institute of Sport Assessment – Achilles" (VISA-A) questionnaire before every injection and on 1 month and 6 months follow-up visits. Univariate analysis was performed to identify differences in functional scores. ResultsThe mean (VISA-A) score improved significantly following HA injections from 34.8 ± 15.2 (range, 11-63) points before the first injection to 53.6 ± 20.9 (range, 15-77) points after 1 month, and 50.7 ± 18.6 (20-75) points after 6 months. No adverse drug reactions were noted.ConclusionsThree consecutive ultrasound-guided intrabursal retrocalcaneal HA injections were found in our cohort to be beneficial in treating IAT.Trial registrationNCT02368561. Registered 23 February 2015. https://clinicaltrials.gov/ct2/show/NCT02368561?term=insertional+achilles&draw=2&rank=2

scholarly journals Treatment of Insertional Achilles Tendinopathy With Ultrasound-Guided Intrabursal Retrocalcaneal Hyaluronic Acid Injection - A Prospective Study

2020 ◽  
Author(s):  
Omer Slevin ◽  
David Segal ◽  
Nissim Ohana ◽  
Eugene Kots ◽  
Viktor Feldman ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Univariate Analysis ◽  
Achilles Tendinopathy ◽  
Ultrasound Guided ◽  
Functional Scores ◽  
Rank 2 ◽  
The Mean ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Abstract Background: Insertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy involving fibrocartilage changes that resemble osteoarthritic changes in articular cartilage. Thus, our primary goal was to evaluate the effect of hyaluronic acid (HA) injections on IAT. Methods: Fifteen IAT ankles (14 patients) were treated with three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of hylan G-F 20 (Synvisc®). Patients answered the "Victorian Institute of Sport Assessment – Achilles" (VISA-A) questionnaire before every injection and on 1 month and 6 months follow-up visits. Univariate analysis was performed to identify differences in functional scores. Results: The mean (VISA-A) score improved significantly following HA injections from 34.8 ± 15.2 (range, 11-63) points before the first injection to 53.6 ± 20.9 (range, 15-77) points after 1 month, and 50.7 ± 18.6 (20-75) points after 6 months. No adverse drug reactions were noted.Conclusions: Three consecutive ultrasound-guided intrabursal retrocalcaneal HA injections were found in our cohort to be beneficial in treating IAT.Trial registration: NCT02368561. Registered 23 February 2015. https://clinicaltrials.gov/ct2/show/NCT02368561?term=insertional+achilles&draw=2&rank=2

scholarly journals Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

2021 ◽  
pp. 107110072110028
Author(s):  
Fabian Greiner ◽  
Hans-Jörg Trnka ◽  
Michel Chraim ◽  
Elena Neunteufel ◽  
Peter Bock
Keyword(s):  
Case Series ◽  
Operative Therapy ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Double Row ◽  
Postoperative Result ◽  
Foot Function ◽  
American Orthopaedic ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. Methods: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. Results: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively ( P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively ( P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up ( P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). Conclusion: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. Level of Clinical Evidence: Level IV, retrospective case series.

scholarly journals A Prospective Study of Posterior (Transpedicular) Approach versus Anterior (Transthoracic/Thoracoabdominal) Approach for Posttraumatic Compression Fracture of Thoracolumbar Vertebra in a Tertiary Care Center: Comparison of Clinical and Radiological Outcomes

2020 ◽  
Author(s):  
Rahul Varshney ◽  
Parthasarathi Datta ◽  
Pulak Deb ◽  
Santanu Ghosh
Keyword(s):  
Prospective Study ◽  
Posterior Approach ◽  
Spinal Injuries ◽  
Anterolateral Approach ◽  
Kyphotic Angle ◽  
Posterior Group ◽  
Thoracoabdominal Approach ◽  
A Prospective Study ◽  
Anterior Group

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Methods  It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p > 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

scholarly journals Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Reem EL-Mallah ◽  
Enas A. Elattar
Keyword(s):  
Treatment Options ◽  
Visual Analogue Score ◽  
Achilles Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Tendon Thickness ◽  
Vas Scores ◽  
Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

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