Epidemiology of insertional and midportion Achilles tendinopathy in runners:A prospective cohort study

Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence and risk factors between insertional AT and midportion AT,though they are considered distinct.This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort.The secondary aim was to explore differences in risk factors between insertional and midportion AT.Methods:Participants were recruited from among registered runners at registration for running events.Questionnaires were completed at baseline,1 month before the event,1 week before the event,and 1 month after the event.Information concerning demographics,training load,registered events,and running-related injuries were collected at baseline.The follow-up questionnaires collected information about new injuries.A pain map was used to diagnose midportion and insertional AT.The primary outcome was the incidence of AT.Multivariable logistic regression analysis was applied to identify risk factors for the onset.Results:We included 3379 participants with a mean follow-up of 20.4 weeks.The incidence of AT was 4.2%.The proportion of insertional AT was 27.7%and of midportion AT was 63.8%;the remaining proportion was a combined type of insertional and midportion AT.Men had a significantly higher incidence(5%,95%confidence interval(95%CI):4.1%-6.0%)than women(2.8%,95%CI:2.0%-3.8%).AT in the past12 months was the most predominant risk factor for new-onset AT(odds ratio(OR)=6.47,95%CI:4.27-9.81).This was similar for both subcategories of AT(insertional:OR=5.45,95%CI:2.51-11.81;midportion:OR=6.96,95%CI:4.24-11.40).Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT(OR=0.59,95%CI:0.36-0.97)or midportion AT(OR=0.47,95%CI:0.23-0.93).Higher age had a significant negative association with insertional AT(OR=0.97,95%CI:0.94-1.00).Conclusion:The incidence of new-onset AT among recreational runners was 4.2%.The proportion of insertional and midportion AT was 27.7%and 63.8%,respectively.AT in the past 12 months was the predominant risk factor for the onset of AT.Risk factors varied between insertional and midportion AT,but we could not identify clinically relevant differences between the 2 subtypes.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture： a meta-analysis

Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. Methods We searched multiple databases in English （including EMBASE, PubMed, and OVID） and in Chinese （including CNKI, WANFANG, and VIP）, as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. Results Eight randomized controlled trials （RCTs） involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher （Z=3.33, P 〈0.01）. However, the moderate （Z--4.27, P 〈0.01） and minor （Z--5.59, P 〈0.01） complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter （Z=2.65, P 〈0.01）. The inability to return to previous level sporting rate and ankle joint decreased range of motion （ROM） rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. Conclusions Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.

Gait analysis combined with the expression of TGF-β1,TGF-β3 and CREB during Achilles tendon healing in rat

Purpose:To observe the changes of gait behavior and the expression of wound healing factors of transforming growth factor-β1(TGF-β1),TGF-β3 and cAMP response element binding protein-1(CREB-1)during the healing of Achilles tendon in a rat model,and to investigate whether gait analysis can be used to evaluate the tendon healing.Methods:Achilles tendon of 40 healthy male Sprague-Dawley rats were transected and sutured to establish the Achilles tendon injury(ATI)model.They were randomly divided into 4 groups based on the observational time point at 1,2,4 and 6 weeks after injury(n=10 for each group).Before modeling,9 rats were randomly selected for CatWalk gait analysis,which contained step cycle,single stance time and average speed.Data were recorded as the normal controls.After then,ATI models were established in the left hind limbs of the all 40 rats(ATI group),while the right hind limbs were only cut and sutured without injury of the Achilles tendon(sham operation group).At 1,2,4 and 6 weeks after injury,the gait behavior of the corresponding group of rats(n=9)as observed and recorded by CatWalk platform.After then,the rats were sacrificed and Achilles tendon of both limbs was harvested.The tendon healing was observed by gross anatomy and histological examination,and the protein and mRNA expression of TGF-β1,TGF-β3,CREB-1 were observed by immunohistochemistry and qPCR.The results of tendon gross grading were analyzed by Wilcoxon rank sum test,and other data were analyzed by one-way analysis of variance among multiple groups.Results:Compared with normal controls,all gait indexes(step cycle,single stance time and average speed)were greatly affected following ATI,which however improved with time.The step cycle was significantly lower at 1,2 and 4 weeks after ATI(compared with normal controls,allp<0.05),but almost returned to the normal level at 6 weeks((0.694±0.102)vs.(0.503±0.094)s,p>0.05).The single stance time of the ATI group was significantly shorter at 1 and 2 weeks after operation((0.078±0.010)s at 1 week,(0.078±0.020)s at 2 weeks,allp<0.001)and revealed no significant difference at 4 weeks(p=0.120).The average speed of ATI group at 1,2,4,6 weeks was significantly lower than that in the normal control group(allp<0.001).Conclusion:Gait behavior indexes are associated with Achilles tendon healing.The study gives an insight of TGF-β1,TGF-β3,CREB-1 changes in the coursing of Achilles tendon healing and these cytokines may be able to be used to regulate the Achilles tendon healing.