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The Achilles tendon connects the calf muscle to the back of the heel. Achilles tendinitis is a common injury that makes the tendon swell, stretch, or tear.

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The Achilles tendon connects the calf muscles to the heel bone. Painful and stiff Achilles tendons are common overuse injuries in people undertaking sports, such as running, but also occur for other reasons in inactive people. The underlying cause is an imbalance between the damage and repair processes in the tendon. Painful Achilles tendons are often disabling and can take a long time to get better. Many treatments exist for this condition and this review set out to find out whether treatment with an injection, with a variety of agents, decreases pain and allows people to return to their previous activities.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Muscle, ligament and tendon injuries frequently occur during activities such as sports, and may be due to tissue degeneration. These injuries are more frequent in particular parts of the body, such as the tendons located in the shoulder, elbow, knee and ankle.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Eccentric exercises for the calf muscles have been shown to be effective for chronic non-insertional Achilles tendinopathy (AT). However, the relative effectiveness of various dosages is unknown. A systematic review of randomized-controlled trials (RCTs) was designed to determine whether an optimum dose of eccentric exercises could be recommended. Three selected RCTs showed positive effects of very similar eccentric exercise protocols for chronic non-insertional AT. Owing to insufficient reported compliance data, a conclusion on the relative effectiveness of various compliances was not feasible. According to our review, the relative effectiveness of various dosages of eccentric exercises for AT is still unclear. However, it appears that highly variable compliance rates result in similar positive outcomes; these findings, therefore, highlight the need for further investigations.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This study aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for lateral elbow tendinopathy (LET). Clinical effectiveness evidence continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new randomised controlled trial (RCT) evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them owing to small sample size. Conclusions regarding cost-effectiveness are also unclear. Future work should be on conducting large scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.

Health Technology Assessment - NIHR Journals Library.

Version: January 2015

To systematically review the current in-vivo evidence for the use of platelet-concentrates (PRP) in the treatment of Achilles tendinopathy and Achilles tendon ruptures in animal models and human applications. A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for animal and human studies on the effect of platelet-concentrates in the treatment of Achilles tendinopathy and ruptures using the terms "Achilles tendon and platelet." The systematic search revealed a total of 149 papers. After excluding duplicates and cases of overlapping data, studies not focusing on in vivo evidence in terms of treatment or outcome, studies without any intervention, studies with unacceptable high attrition, one Chinese and one Swedish study, the remaining 14 manuscripts were included. The key finding of our study is evidence in support of a statistically significant effect of platelet concentrates in the treatment of Achilles tendon ruptures in vivo in animal models and human application, consistent with a medium to large sized effect. This effect is most likely attributable to fastened and enhanced scar tissue maturation. There was no evidence for a beneficial effect of platelets in Achilles tendinopathy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Platelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

PURPOSE: Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

INTRODUCTION: Achilles and patellar tendinopathy are overuse injuries that are common among athletes. Isolated eccentric muscle training has become the dominant conservative management strategy for Achilles and patellar tendinopathy but, in some cases, up to 45 % of patients may not respond. Eccentric-concentric progressing to eccentric (Silbernagel combined) and eccentric-concentric isotonic (heavy-slow resistance; HSR) loading have also been investigated. In order for clinicians to make informed decisions, they need to be aware of the loading options and comparative evidence. The mechanisms of loading also need to be elucidated in order to focus treatment to patient deficits and refine loading programmes in future studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

BACKGROUND: Clinicians manage midportion Achilles tendinopathy (AT) using complex clinical reasoning underpinned by a rapidly developing evidence base.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

BACKGROUND: Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. The aim of this study was to conduct a systematic review and meta-analysis (where possible) of the evidence for physical therapies for AT management.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

OBJECTIVE: To summarize and evaluate the current diagnostic accuracy of clinical measures used to diagnose Achilles tendon injuries.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

BACKGROUND: Although there has been a recent increase in interest regarding injectable therapy for noninsertional Achilles tendinosis, there are currently no clear treatment guidelines for managing patients with this condition. The objective of this study was (1) to conduct a systematic review of clinical outcomes following injectable therapy of noninsertional Achilles tendinosis, (2) to identify patient-specific factors that are prognostic of treatment outcomes, (3) to provide treatment recommendations based on the best available literature, and (4) to identify knowledge deficits that require further investigation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review concluded that eccentric exercise had the most evidence of effectiveness in the treatment of mid-portion Achilles tendinopathy, and that more research is needed on the value of a range of alternative therapies. The authors’ conclusions reflected the results of the review, but poor reporting and lack of a validity assessment mean that their reliability is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

The authors concluded that conservative treatment for insertional tendinopathy of the Achilles favoured eccentric loading and shock wave therapy, but there was limited evidence to assess their effectiveness. The effectiveness of operational interventions remained inconclusive. There was a lack of detailed information on study results and no statistical comparisons; the authors' conclusions seem to reflect the limitations of the evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

This generally well-conducted review assessed the efficacy of eccentric overload training in patients with chronic Achilles tendinopathy. The authors concluded that while the treatment appears promising, the magnitude of its effect could not be determined. This conclusion is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

The review found satisfactory evidence for the effectiveness of low-energy Extracorporeal shock wave therapy in the treatment of chronic insertional and noninsertional Achilles tendinopathies at a minimum three months’ follow-up. Uncertainty about the reliability of these conclusions was created by lack of meta-analysis (especially for RCTs), clinical variations between studies, small sample sizes and possible language bias.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review assessed the effectiveness of eccentric exercise training for patients with Achilles tendinopathy. The authors concluded that eccentric exercise training resulted in modest but significant post-treatment clinical benefits. Owing to the uncertain quality of the included studies and the poor reporting of some of the review processes, these conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Although eccentric exercise training has shown favorable results in chronic mid-portion Achilles tendinopathy, the optimum dosage remains unknown. A systematic review of the literature was performed in accordance with the PRISMA guidelines, in order to describe different exercise protocols and to determine the most effective training parameters. An extensive search in MEDLINE, EMBASE, CINAHL, and CENTRAL revealed 14 randomized and clinical controlled trials. Strong evidence was found for the Alfredson exercise protocol. In this 12-week protocol, exercises are performed 3 × 15 repetitions twice daily, both with a straight and bent knee. Exercises are performed at slow speed, and load is increased when exercises are without pain. Strong evidence was also found for gradual onset of exercises during the first week of the Alfredson program, but no uniformity of protocols exists. Other exercise protocols did achieve similar results, but many studies had some methodological shortcomings or lacked a detailed description of their training parameters. Because of the heterogeneity of study populations and outcome measures, and lack of reporting of training compliance data, a definitive conclusion regarding the most effective training parameters could not be made. Further research comparing the content of different exercise protocols is warranted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

This review compared the effectiveness of eccentric exercise programmes with other treatments to manage chronic Achilles tendinosis in adults. The authors concluded that eccentric exercises should be considered as first line treatment. Given the variability in study methodology, interventions and outcome measures, the limited data reported by the studies and the limited data analysis, the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

PURPOSE: The purpose of this study was to provide a comprehensive review of the current literature on tendoscopy of the foot and ankle and assign an evidence-based grade of recommendation for or against intervention.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

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