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Achilles Tendinopathy


Nicola Maffulli, MD, MS, PhD, FRCS(Orth)1, Umile Giuseppe Longo, MD2, and Vincenzo Denaro, MD2


In Achilles tendinopathy, there is pain and swelling in and around the Achilles tendon (AT), mainly arising from overuse. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and a subsequent increase in non-collagenous matrix. Despite the social and economic relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. The diagnosis of Achilles tendinopathy is mainly based on careful history-taking and detailed clinical examination. The latter remains the best diagnostic tool. At present, only limited scientifically proven management modalities exist. New minimally invasive techniques involving stripping neovessels from the Kager’s triangle of the AT have been described, and seem to allow faster recovery and accelerated return to sport compared with open surgery. Adv Orthop 2009;1(4):143–150.

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