Successful treatment with painful eccentric training for patients with chronic painful midportion Achilles tendinosis started research on pain mechanisms involving ultrasound + Doppler investigations and immunohistoch...Successful treatment with painful eccentric training for patients with chronic painful midportion Achilles tendinosis started research on pain mechanisms involving ultrasound + Doppler investigations and immunohistochemical analyses of tendon tissue specimens. This research has resulted in a better understanding of the pain mechanisms involved in the chronic painful Achilles and patellar tendon, and based on these findings new non tendon-invasive treatment methods beneficial for the patients have been invented. This is a mini review showing the background and research that resulted in the highly successful mini surgical treatments for mid-portion Achilles tendinopathy and proximal patellar tendinopathy.展开更多
Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition...Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.展开更多
Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patter...Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.展开更多
Treatment with Ultrasound (US) and Color Doppler (CD)-guided surgical scraping has shown good short-term clinical results in patients with chronic painful midportion Achilles tendinopathy. The objective was to prospec...Treatment with Ultrasound (US) and Color Doppler (CD)-guided surgical scraping has shown good short-term clinical results in patients with chronic painful midportion Achilles tendinopathy. The objective was to prospectively follow the patients 1-year after surgery. Material: Sixty- four tendons in 47 patients (28 men and 19 women, mean age 52 (+/-12 years) on different activity levels) were in local anaestesia operated with US+CD-guided surgical scraping. In 43/64 tendons, there was also removal of the plantaris tendon. Methods: Questionnaires evaluating activity level, VAS for pain during activity, satisfaction with treatment result, and the SF-36 score (quality of life), were used before and 1-year after surgery. Results: At follow-up, the mean VAS for pain during activity had decreased from 62 (+/-20) before surgery to 15 (+/-15) after surgery (p < 0.001). All patients were satisfied with the result and had returned to full tendon loading activity. There were no complications. Both the physical and psychological parameters in the SF-36 score had improved significantly. Conclusions: For patients with chronic painful midportion Achilles tendinopathy, US+CD-guided surgical scraping, often combined with plantaris tendon removal, seems to be an efficient treatment method to recover physically and psychologically.展开更多
文摘Successful treatment with painful eccentric training for patients with chronic painful midportion Achilles tendinosis started research on pain mechanisms involving ultrasound + Doppler investigations and immunohistochemical analyses of tendon tissue specimens. This research has resulted in a better understanding of the pain mechanisms involved in the chronic painful Achilles and patellar tendon, and based on these findings new non tendon-invasive treatment methods beneficial for the patients have been invented. This is a mini review showing the background and research that resulted in the highly successful mini surgical treatments for mid-portion Achilles tendinopathy and proximal patellar tendinopathy.
文摘Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.
文摘Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.
文摘Treatment with Ultrasound (US) and Color Doppler (CD)-guided surgical scraping has shown good short-term clinical results in patients with chronic painful midportion Achilles tendinopathy. The objective was to prospectively follow the patients 1-year after surgery. Material: Sixty- four tendons in 47 patients (28 men and 19 women, mean age 52 (+/-12 years) on different activity levels) were in local anaestesia operated with US+CD-guided surgical scraping. In 43/64 tendons, there was also removal of the plantaris tendon. Methods: Questionnaires evaluating activity level, VAS for pain during activity, satisfaction with treatment result, and the SF-36 score (quality of life), were used before and 1-year after surgery. Results: At follow-up, the mean VAS for pain during activity had decreased from 62 (+/-20) before surgery to 15 (+/-15) after surgery (p < 0.001). All patients were satisfied with the result and had returned to full tendon loading activity. There were no complications. Both the physical and psychological parameters in the SF-36 score had improved significantly. Conclusions: For patients with chronic painful midportion Achilles tendinopathy, US+CD-guided surgical scraping, often combined with plantaris tendon removal, seems to be an efficient treatment method to recover physically and psychologically.
