Achilles tendon,Achilles tendons,Achilles tendon injury,Achilles tendon injuries,Achilles tendonitis,Achilles tendinosis
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O’Brien, M. Functional anatomy and physiology of tendons (1992) Clinical Sports Medicine 11:505-20 Key Point: The Achilles tendon is the thickest and strongest tendon in the body.

Öhberg, L, Lorentzon, R, and Alfredson, H. (2004) Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine 38:8-11. Key point: Ultrasound studies indicate that most of the 12 patients with Achilles tendinosis who were treated with 12 weeks of eccentric calf muscle training showed a localized decrease in tendon thickness and a normalized tendon structure. The remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.

 

Paavola, M., Kannus, P., Paakkala, T., Pasanen, M., Järvinen, M. (2000). Long-term prognosis of patients with Achilles tendinopathy. American Journal of Sports Medicine 28, 634–42. Key point: 8 years after 83 patients suffered an Achilles tendon injury (and 30% had surgery) 84% had fully recovered or only experienced mild pain with strenuous exercise.

 

Ryan, A.J. (1978). Injections for tendon injuries: Cure or cause. Physician and Sportsmedicine 6 (September), 39. Key point: Cortisone injections may make a tendon more likely to rupture.

 

Schepsis, A.A., Jones, H., and Andrew L. Haas, A.L. Achilles Tendon Disorders in Athletes. American Journal of Sports Medicine.2002; 30: 287-305.

Key points: a) Achilles tendon injuries are among the more common injuries seen by sports medicine physicians and b) although most cases of this disorder are successfully treated without surgery, a small subgroup of cases may benefit from surgery.

 

Shrier, I., Matheson, G.O., Kohl, H.W. (1996). Achilles tendonitis: Are corticosteroid injections useful or harmful? Clinical Journal of Sports Medicine 6, 245–50. Key points: a) there is no evidence to suggest that cortisone injections help with the treating the Achilles tendon, and b) the hypothesis that cortisone injections make a tendon more likely to rupture has not yet been confirmed in a study on humans.

 

Smart, G.W., Taunton, J.E., Clement, D.B. (1980). Achilles tendon disorders in runners: A review. Medicine and Science in Sports and Exercise 12, 231–43. Key points: a) The calf muscles’ rapid eccentric shortening at heel strike followed by rapid contraction at toe-off may cause degeneration of the Achilles tendon, b) Achilles tendon injuries may be caused by sudden increases in training distances, too many speed sessions, increased hill running, heavy training after a layoff, and inflexibility of the calf caused by too much training and not enough stretching, and c) when performed by an experienced surgeon, surgery for Achilles tendinosis (removal of the sheath and then the scar tissue underneath) has a very high success rate.

 

Stanish, W.D., Curwin, S., Rubinovich, M. (1985). Tendinitis: The analysis and treatment for running. Clinics in Sports Medicine 4, 593–609. and Stanish, W.D., Rubinovich, R.M., Curwin, S. (1986). Eccentric exercise in chronic tendinitis. Clinical Orthopedics

208, 65–68. Key point: strengthening of the Achilles tendons with eccentric loading should begin as soon after Achilles tendinosis is diagnosed as possible.

 

Wong, W, Barrass, V, Maffulli, N (2002) Quantitative Review of Operative and Nonoperative Management of Achilles Tendon Ruptures American Journal of Sports Medicine 30:565-575 (2002) Key point: analysis of 125 peer reviewed articles reveals that open repair and early mobilization give the best functional recovery and an acceptable complication rate.

Woods, C, Hawkins, R, Hulse, M, and Hodson, A. (2002) The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of preseason injuries. British Journal of Sports Medicine 36:436-441. Key point: 91 professional football (soccer) clubs were audited over a two year period, revealing that Achilles tendonitis is more likely to occur in the pre-season rather than the season. One third of its occurrences were in the preseason.  

 

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