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BMJ Open Nov 2020The objective of this study is to summarise and analyse the current literature about what progression criteria are applied in loading exercise programmes in lower limb...
OBJECTIVE
The objective of this study is to summarise and analyse the current literature about what progression criteria are applied in loading exercise programmes in lower limb tendinopathies and their evidence and effectiveness.
DESIGN
Systematic review.
METHODS
PubMed, Embase, Scopus and PED were searched from inception to 24 September 2020. The inclusion criteria were randomised controlled trials that included patients with midportion Achilles, patellar or gluteal tendinopathy; assessed function, pain or performance; included at least one group where progressive physical exercise was administered as monotherapy; included at least a control group. We excluded studies that included subjects with previous tendon surgical treatment; studies with control group that conducted a supplemented modality of the exercise performed in the intervention group. A narrative synthesis was conducted. Cohen's d and the percentage of change of main clinical and performance outcomes were obtained. Methodological quality was assessed using the PEDro scale.
RESULTS
Thirty studies that described progression criteria were included. Six types of criteria grouped in two categories were identified and included in a new classification proposal: pain as a primary criterion (evoking and avoid-pain based), and pain and symptom control as a secondary criterion (conditioning stages, fatigue-based, subjective perception and temporary linear increase). Most of the studies applied a pain-based criterion. Criteria based on conditioning stages were also commonly applied. Other criteria such as fatigue, a temporary linear increase, or the subjective perception of the patient's abilities were occasionally applied.
CONCLUSIONS
There is a predominant use of pain-based criteria, but the utilisation of these criteria is not supported by strong evidence. This review evidences the need for studies that compare the same exercise programme using different progression criteria. A new classification of the existing progression criteria is proposed based on the use of pain as the primary or secondary criterion.
PROSPERO REGISTRATION NUMBER
CRD42018110997.
Topics: Achilles Tendon; Exercise; Exercise Therapy; Humans; Lower Extremity; Pain; Tendinopathy
PubMed: 33444210
DOI: 10.1136/bmjopen-2020-041433 -
Foot (Edinburgh, Scotland) Dec 2022Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment.
METHODS
The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ('plasma' OR 'platelet-rich' OR 'platelet-rich plasma' or 'PRP') AND ('Achilles tendon rupture/tear' OR 'calcaneal tendon rupture/tear' OR 'tendo calcaneus rupture/tear'). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf-circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random- and fixed-effects models.
RESULTS
After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was 41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re-rupture (OR 1.13, 95% CI, 0.46-2.80, p = 0.79).
CONCLUSION
PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.
Topics: Humans; Adult; Tendon Injuries; Achilles Tendon; Rupture; Platelet-Rich Plasma; Ankle Injuries; Treatment Outcome
PubMed: 36037774
DOI: 10.1016/j.foot.2022.101923 -
Foot & Ankle Orthopaedics Oct 2023As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different...
BACKGROUND
As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different treatment options and recommend a literature-based algorithm.
METHODS
In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes and complications were calculated.
RESULTS
Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between the tendon stumps: >3 months: FHL transfer; <3 months (a) gap <2 cm, end-to-end repair; (b) gap 2 to 5 cm, gastrocnemius transfer, (c) gap >5 cm, semitendinosus autograft.
CONCLUSION
Surgical management of CATR produced improvements in patient-reported outcome scores at midterm follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision making for this complex problem.
PubMed: 37810568
DOI: 10.1177/24730114231200491 -
Surgery Journal (New York, N.Y.) Jul 2021The most common cause of the Achilles tendon ruptures in the U.S. population is sports, basketball is one among them. It is not one of the most frequent injuries of... (Review)
Review
The most common cause of the Achilles tendon ruptures in the U.S. population is sports, basketball is one among them. It is not one of the most frequent injuries of this sport, but it is one of the most serious and impactful in its practice. The objective of this work is to gather evidence and evaluate the relationship between Achilles' tendon ruptures and basketball. This study designed as a systematic review. A search of literature in the databases PubMed, Cochrane Library, and ClinicalTrials.gov was conducted during January and February 2020. After the search and selection, three relevant articles were obtained due to their epidemiological content, Raikin et al and Lemme et al. In 2013 and 2018, they, respectively, conducted studies in U.S. populations, establishing sport as the most frequent injury mechanism in Achilles' tendon ruptures. It was analyzed according to injury mechanism, gender, body mass index (BMI), and age. In both studies, the lesion resulted more frequently in men and the sport involved in most of the cases was basketball (32 and 42.6%, respectively). In 2019, Lemme et al published an epidemiological design analyzing the Achilles tendon ruptures in the National Basketball Association (NBA), identifying risk factors and results in professional players. After suffering the injury, 36.8% of the patients had to retire or were holders in less than 10 games to the rest of their sports career. The relationship between basketball and Achilles' tendon rupture is clear in the general population. Despite this, new studies are required to complement the evidence obtained so far.
PubMed: 34541320
DOI: 10.1055/s-0041-1733988 -
Annals of Translational Medicine Feb 2019Soft tissue dysfunction can result from the degeneration of tissues as in the case of degenerative tendinopathy or from the build-up of problematic scar tissue, which... (Review)
Review
Soft tissue dysfunction can result from the degeneration of tissues as in the case of degenerative tendinopathy or from the build-up of problematic scar tissue, which can be the result of several aggravating factors, including overuse injuries, acute or chronic trauma, or as a result of surgery. This dysfunction often results in impaired movement, pain, and swelling of the affected area, which can lead to patient dissatisfaction and a lower quality of life. These soft tissue dysfunctions also have a marked economic impact. Although a number of traditional treatments attempt to address these issues, no optimal treatment choice has emerged. Traditional treatments are not always successful, can be invasive, and can consume many medical resources. A relatively new treatment approach, Astym therapy, is a potentially useful, non-invasive, more cost-effective option. This therapy was developed to address soft-tissue dysfunctions by stimulating the regeneration of soft tissues and the resorption of inappropriate scar tissue/fibrosis. It has been reported to help with the resorption and remodeling of abnormal tissue, thereby leading to improved motion, function and pain relief. The purpose of this analysis was to review the published literature related to Astym therapy on various musculoskeletal disorders. Specifically, we evaluated the effectiveness of this therapeutic method on disorders related to the: (I) knee; (II) upper extremity; (III) hamstring muscles; and (IV) ankle and Achilles tendon injuries.
PubMed: 30963065
DOI: 10.21037/atm.2018.11.49 -
Journal of Biomechanics Jun 2016Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of... (Review)
Review
Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of tendinopathy has not been fully understood, therapeutic mechanical loading programs have emerged as being the treatment of choice. In this light, mechanical properties of the tendon and their response to changes in loading or unloading have been the subject of many previous investigations. One of these properties often investigated is strain, a measure of relative deformation. By means of a systematic review, an overview was given of research in this field, with a primary objective to list the methods used and secondary aim to synthesize data on strain mapping in the Achilles tendon. Following the guidelines of the PRISMA statement, 47 articles were found appropriate for qualitative assessment. Achilles tendon strain has been investigated across a variety of contexts, including the response to exercise, walking, unloading, ageing, hormonal changes and weight. Only three studies investigated the effect of the presence of tendinopathy on strain. Ultrasound was the most often used imaging modality to measure or estimate strain. Further methodological parameters, e.g. the location of measurement, differed greatly between all different studies. Nearly all studies considered global strain. Some studies investigated the transverse strain response of the Achilles tendon. Recently, however, the role of local - intratendinous - strain distribution has been found to be of critical importance and further studies should focus on imaging modalities to investigate these local changes.
Topics: Achilles Tendon; Diagnostic Imaging; Humans; Stress, Mechanical; Tendinopathy; Weight-Bearing
PubMed: 27113537
DOI: 10.1016/j.jbiomech.2016.02.057 -
Sports Medicine and Health Science Sep 2022This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the... (Review)
Review
This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1 of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%, 0.04-0.07). The prevalence of Achilles tendon rupture was 0.03 (95%, 0.02-0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%, 0.04-0.11), and the lowest among the group under 18 years old (0.02; 95%, 0.01-0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%, 0.14-0.20) and (0.06; 95%, 0.02-0.11), respectively. The prevalence of AT in athletes (0.06; 95%, 0.04-0.08) was higher than that of amateur exercisers (0.04; 95%, 0.02-0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.
PubMed: 36090915
DOI: 10.1016/j.smhs.2022.03.003 -
World Journal of Orthopedics May 2015Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete... (Review)
Review
Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.
PubMed: 25992315
DOI: 10.5312/wjo.v6.i4.380 -
EFORT Open Reviews Jul 2024The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented. However, it is not clear whether...
PURPOSE
The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented. However, it is not clear whether different molecules have the same effect on these complications. The purpose of this study was to document Achilles tendon complications for the most prescribed fluoroquinolones molecules.
METHODS
A literature search was performed on Pubmed, Cochrane, Embase, and Web of Science databases up to April 2023. Inclusion criteria: studies of any level of evidence, written in English, documenting the prevalence of AT/ATR after fluoroquinolone consumption and stratifying the results for each type of molecule. The Downs and Black's 'Checklist for Measuring Quality' was used to evaluate the risk of bias.
RESULTS
Twelve studies investigating 439,299 patients were included (59.7% women, 40.3% men, mean age: 53.0 ± 15.6 years). The expected risk of AT/ATR was 0.17% (95% CI: 0.15-0.19, standard error (s.e.): 0.24) for levofloxacin, 0.17% (95% CI: 0.16-0.19, s.e.: 0.20) for ciprofloxacin, 1.40% (95% CI: 0.88-2.03, s.e.: 2.51) for ofloxacin, and 0.31% (95% CI: 0.23-0.40, s.e.: 0.77) for the other molecules. The comparison between groups documented a significantly higher AT/ATR rate in the ofloxacin group (P < 0.0001 for each comparison). Levofloxacin and ciprofloxacin showed the same risk (P = n.s.). The included studies showed an overall good quality.
CONCLUSION
Ofloxacin demonstrated a significantly higher rate of AT/ATR complications in the adult population, while levofloxacin and ciprofloxacin showed a safer profile compared to all the other molecules. More data are needed to identify other patient and treatment-related factors influencing the risk of musculoskeletal complications.
PubMed: 38949172
DOI: 10.1530/EOR-23-0181 -
Sports Medicine (Auckland, N.Z.) Sep 2014The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing. (Review)
Review
BACKGROUND
The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing.
OBJECTIVES
The aim of this review was to systematically summarize predictors influencing Achilles tendon rupture (ATR) risk.
METHODS
A systematic literature search was performed of reported determinants influencing the ATR risk. Studies were eligible if there was: (i) description of determinants predicting ATR; (ii) an outcome defined as ATR; (iii) any study design with at least ten adults included with ATR; (iv) use of statistical tests regarding differences between patients with an ATR and healthy controls; (v) a full text article available; (vi) an article written in English, German or Dutch. Quality assessment was done using a standardized criteria set. Best-evidence synthesis was performed.
RESULTS
We included 31 studies, of which two (6.5%) were considered high-quality studies. Moderate evidence was found for increased ATR risk and decreased fibril size of Achilles tendon.
CONCLUSION
Based on the results of this systematic review there is moderate evidence that decreased tendon fibril size increases the ATR risk. There is limited evidence for many other factors, some of which are modifiable, such as increased body weight, oral corticosteroid use and quinolone use and living in an urban area, and therefore may be of interest in future studies. Furthermore, these results showed that more high-quality studies are needed for evaluating the determinants influencing the ATR risk.
Topics: Achilles Tendon; Adrenal Cortex Hormones; Age Factors; Diabetes Complications; Foot; Genetic Predisposition to Disease; Humans; Musculoskeletal Diseases; Obesity; Pronation; Quinolones; Renal Insufficiency; Residence Characteristics; Risk Factors; Rupture; Sex Factors
PubMed: 24929701
DOI: 10.1007/s40279-014-0200-z