Department of Surgery, Satakunta Health Care District, Pori, Finland. ; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland.
Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland. ; Department of Surgery, Turunmaan District Hospital, Turku, Finland. ; Hospital Neo, Turku, Finland.
Orthop J Sports Med. 2014 Dec 19;2(12):2325967114562371. doi: 10.1177/2325967114562371. eCollection 2014 Dec.
Nonsurgical treatments for chronic Achilles tendinopathy (AT) results in unpredictable success rates. Surgical treatment may be chosen as reports show mostly encouraging but variable success rates depending on the pathology. The distribution of surgically confirmed pathologies in AT is largely unknown.
To ascertain the distributions of macroscopically observed anomalies in participants undergoing surgical treatment for chronic AT.
Case series; Level of evidence, 4.
The main macroscopic pathologies of 1661 chronic Achilles tendon overuse injuries, which were diagnosed and surgically treated by a single surgeon, were reviewed. The surgeries were performed on professional and recreational athletes during the years 1976-1980, 1986-1990, 1996-2000, and 2006-2010. Surgical diagnoses, along with age- and sport-specific characteristics, were collected retrospectively from patient records.
The relative proportion of tendinosis increased during the study period from 4.2% to 21%, and paratenonitis decreased from 50% to 26%. Retrocalcaneal pathologies were the most common surgically confirmed lesions at 30%, while the mean age at surgery increased by 11 years over the entire study period.
Surgically confirmed pathologies in and around the Achilles tendon showed coherent changes, chronic paratenonitis, and retrocalcaneal problems as the most prevalent findings. The classification of midportion and insertional tendinopathy and retrocalcaneal bursitis in AT should strictly be used as a clinical diagnosis. During surgical evaluations, the diagnosis is further clarified as more specific pathologies may be identified.
非手术治疗慢性跟腱病（AT）的成功率难以预测。手术治疗可能是一种选择，因为报告显示，根据病理情况，手术成功率大多是令人鼓舞的，但存在差异。手术确认的 AT 病变的分布情况尚不清楚。
确定接受慢性 AT 手术治疗的患者中肉眼观察到的异常分布情况。
病例系列；证据水平，4 级。
回顾了由一位外科医生诊断和手术治疗的 1661 例慢性跟腱过度使用损伤的主要宏观病理。这些手术是在 1976-1980 年、1986-1990 年、1996-2000 年和 2006-2010 年期间为专业和业余运动员进行的。从患者病历中回顾性收集了手术诊断以及与年龄和运动相关的特征。
在研究期间，跟腱病的相对比例从 4.2%增加到 21%，而腱旁炎从 50%减少到 26%。跟腱后病变是最常见的手术确认病变，占 30%，而整个研究期间的手术年龄增加了 11 岁。
跟腱内和周围的手术确认病变显示出一致的变化，慢性腱旁炎和跟腱后问题是最常见的发现。中节段和插入部跟腱病和跟腱后囊炎的分类应严格作为临床诊断使用。在手术评估中，随着可能识别出更具体的病变，诊断会进一步明确。
