Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Foot Ankle Int. 2020 Jun;41(6):744-754. doi: 10.1177/1071100720914605. Epub 2020 Apr 30.
Achilles tendinopathy is a common clinical problem that can be either insertional or noninsertional. A variety of treatment methods have been described, although little consensus exists on an optimal method or methods. We sought to investigate the current evidence on different treatment methods for noninsertional Achilles tendinopathy, with a focus on functional outcomes.
We performed a review of the available literature in PubMed and the Cochrane Central Register of Controlled Trials. Data from included studies were categorized according to treatment method and analyzed with respect to functional outcome and complication rate.
In total, 1420 abstracts were reviewed, of which 72 articles containing 3523 patients met inclusion criteria. Within the 72 studies included, 6 operative techniques and 19 nonoperative treatments were evaluated.
A wide variety of treatments are available for noninsertional Achilles tendinopathy, although newer treatments and most operative methods lack high-level evidence. Eccentric exercise is the most thoroughly studied and supported nonoperative treatment, while tenotomy and debridement is the operative procedure with the most evidence of efficacy. Platelet-rich plasma injections and extracorporeal shockwave therapy have proven to be viable second-line nonoperative treatments. Gastrocnemius recession and flexor hallucis longus transfer have shown benefit in case series.
Level II, systematic review.
跟腱病是一种常见的临床问题，可分为插入性和非插入性。虽然对于最佳治疗方法尚未达成共识，但已经描述了多种治疗方法。我们旨在研究非插入性跟腱病不同治疗方法的现有证据，重点关注功能结果。
我们在 PubMed 和 Cochrane 对照试验中心注册库中进行了文献回顾。根据治疗方法对纳入研究的数据进行分类，并分析其功能结果和并发症发生率。
共审查了 1420 篇摘要，其中有 72 篇文章包含 3523 例患者符合纳入标准。在纳入的 72 项研究中，评估了 6 种手术技术和 19 种非手术治疗方法。
尽管较新的治疗方法和大多数手术方法缺乏高级别证据，但非插入性跟腱病有多种治疗方法可供选择。离心运动是研究最充分、支持最有力的非手术治疗方法，而跟腱切断术和清创术是疗效证据最多的手术方法。富血小板血浆注射和体外冲击波疗法已被证明是可行的二线非手术治疗方法。跟腱后滑囊炎和屈趾长肌转移在病例系列研究中显示出益处。
二级，系统评价。
