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Online ISSN 1827-1707
Chaudhry S. 1, Maffulli N. 2
1 Department of Trauma and Orthopaedic Surgery City Hospital, Birmingham, UK
2 Department of Trauma and Orthopaedic Surgery Keele University School of Medicine Stoke on Trent, UK
Achilles tendinopathy is a common clinical condition associated with significant morbidity in athletic and nonathletic populations. The injury is usually secondary to overuse; characterized by the chronic degenerative changes of tendinosis rather than the acute inflammatory changes of tendinitis. The aetiology of Achilles tendinopathy is probably multifactorial resulting from a combination of intrinsic and extrinsic factors. Excessive loading of the tendon during vigorous training activities is regarded as the main pathological stimulus. In its early phases, Achilles tendinopathy often responds favorably to conservative treatment with rest or modified activity, orthoses, cryotherapy, stretching, deep friction massage and correction of provoking factors. Surgery is generally recommended after exhausting conservative management, usually after at least 3 to 6 months. Operative management includes debridement, excision of the macroscopic adhesions, and excision of any intratendinous lesion that is identified on preoperative imaging examinations or intraoperatively. Long-standing Achilles tendinopathy is associated with poor postoperative results, with a greater rate of reoperation before reaching an acceptable outcome. Nonathletic subjects may experience a longer recovery period, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.