Alfredson Håkan, Spang Christoph
ISEH, University College London Hospitals, London, UK.
Department of Community Research and Rehablilitation, Sports Medicine Unit, Umeå University, Umeå, Sweden.
BMJ Open Sport Exerc Med. 2020 Jun 9;6(1):e000769. doi: 10.1136/bmjsem-2020-000769. eCollection 2020.
Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.
Eleven patients (eight men and three women) with a mean age of 44 years (range 24-62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.
At follow-up 21 (median, range 12-108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0-52) to 91 (range 33-100) (p<0.01).
In patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.
IV Case series.
众所周知，插入性跟腱病难以治疗，尤其是当存在腱内骨质病变时。本研究是关于慢性插入性跟腱疼痛且伴有主要腱内骨质病变以及滑囊和肌腱病变的患者的病例系列，仅通过切除皮下滑囊进行治疗。
纳入11例患者（8例男性和3例女性），平均年龄44岁（范围24 - 62岁），共15处跟腱附着点存在慢性（>6个月）疼痛症状。所有患者的超声检查均显示腱内骨质病变以及肌腱和皮下滑囊病变，全部接受了仅开放切除整个皮下滑囊的手术治疗。术后患者穿着后跟开口的鞋子进行6周的完全负重行走。
术后随访21个月（中位数，范围12 - 108个月），9/11例患者（12/15处肌腱）对手术结果满意，10/11例患者（13/15处肌腱）恢复了之前的运动和娱乐活动。VISA - A评分中位数从41（范围0 - 52）提高到91（范围33 - 100）（p<0.01）。
对于患有慢性疼痛性插入性跟腱病且伴有腱内骨质病变、肌腱和滑囊病变的患者，仅开放切除皮下滑囊可缓解疼痛并允许进行跟腱负重活动。该病例系列的结果凸显了对插入性跟腱病疼痛机制进行更多研究的必要性以及进行随机研究以强化结论的必要性。
IV级病例系列。
