J Orthop Sports Phys Ther. 2023 Apr;53(4):217-234. doi: 10.2519/jospt.2023.11330. Epub 2023 Jan 23.
To (1) evaluate whether the defining characteristics of previously reported Achilles tendinopathy subgroups were reproducible in a cohort with midportion Achilles tendinopathy and (2) compare recovery trajectories and outcomes. Prospective single cohort study. Participants (n = 114; 57 women; age [mean ± standard deviation]: 47 ± 12 years) received the Silbernagel protocol and were evaluated at baseline, and at 8, 16, and 24 weeks. Subgroups were identified using mixture modeling. Main effects of group and time, and interaction effects were evaluated using linear mixed models for 23 outcome measures representing symptoms, lower extremity function, tendon structure, psychological factors, and patient-related factors. Recovery trajectories were reported descriptively to reflect clinically meaningful change for outcomes. Activity-Dominant (n = 34), Function-Dominant (n = 38), Psychosocial-Dominant (n = 27), and Structure-Dominant (n = 15) subgroups were identified. There were significant effects of group and time for all primary outcome measures, except heel-rise and viscosity limb symmetry indexes. The Activity- and Function-Dominant subgroups achieved functional recovery despite persisting symptoms. The Psychosocial-Dominant subgroup reported the greatest impairments in symptom and foot- and ankle-related quality of life at all time points. The Structure-Dominant subgroup experienced delayed improvement in symptoms and was the only subgroup to not achieve structural recovery. No subgroup met our criteria for complete recovery. The defining characteristics of Achilles tendinopathy subgroups were reproduced in a cohort with midportion Achilles tendinopathy. The Activity- and Function-Dominant subgroups had superior outcomes compared to the Psychosocial- and Structure-Dominant subgroups for symptomatic, functional, and structural recovery. .
（1）评估先前报道的跟腱病亚组的定义特征在中段跟腱病队列中是否具有可重复性，以及（2）比较恢复轨迹和结果。前瞻性单队列研究。参与者（n=114；57 名女性；年龄[平均值±标准差]：47±12 岁）接受了 Silbernagel 方案，并在基线、8 周、16 周和 24 周进行评估。使用混合模型确定亚组。使用线性混合模型评估组和时间的主要影响以及交互效应，用于 23 个代表症状、下肢功能、跟腱结构、心理因素和患者相关因素的结果测量。恢复轨迹以描述性方式报告，以反映结果的临床有意义变化。活动主导型（n=34）、功能主导型（n=38）、心理社会主导型（n=27）和结构主导型（n=15）亚组。除了足跟抬高和粘度肢体对称性指数外，所有主要结果测量的组和时间都有显著影响。尽管存在症状，但活动和功能主导型亚组实现了功能恢复。心理社会主导型亚组在所有时间点报告了最大的症状和足部和踝关节相关生活质量受损。结构主导型亚组症状改善延迟，是唯一未达到结构恢复的亚组。没有亚组符合我们的完全恢复标准。中段跟腱病队列中重现了跟腱病亚组的定义特征。与心理社会和结构主导型亚组相比，活动和功能主导型亚组在症状、功能和结构恢复方面的结果更好。
