插入性跟腱病：与较短游离肌腱的新关联。

Mifsud Tiziana, Gatt Alfred, Chockalingam Nachiappan, Micallef Stafrace Kirill, Padhiar Nat

Faculty of Health Sciences, University of Malta, Malta; Orthopaedics Department, Mater Dei Hospital, Malta.

Faculty of Health Sciences, University of Malta, Malta.

Foot (Edinb). 2025 Jun;63:102164. doi: 10.1016/j.foot.2025.102164. Epub 2025 Apr 28.

BACKGROUND

Achilles tendinopathy is a common overuse injury among athletes, classified into mid-portion and insertional types. While existing literature primarily emphasizes mid-portion tendinopathy as the more prevalent form, emerging evidence highlights the significance of insertional tendinopathy. Variations in clinical presentation warrant further investigation, particularly regarding anatomical differences that could inform treatment strategies and rehabilitation protocols.

PURPOSE

This study aimed to assess the prevalence of Achilles tendon pathologies and explore anatomical differences in the length of the free tendon between insertional and mid-portion tendinopathy.

STUDY DESIGN

This study represents a cross-sectional analysis conducted as part of a larger longitudinal study on the mechanical properties of patients with Achilles tendinopathy.

METHODS

A total of 103 patients (38.8 % males, 61.2 % females, age: 53 ± 12.8 years, body Mass Index (BMI): 30 ± 7.4 kg/m, 60 % sedentary while 40 % active) diagnosed with Achilles tendon pathologies from across the Maltese islands were recruited for ultrasound assessments to measure tendon length and evaluate associated anatomical characteristics. Participants were categorised based on the type of tendinopathy.

RESULTS

A higher prevalence of insertional tendinopathy (67.9 %) was identified compared to mid-portion tendinopathy (20.3 %). Notably, participants with insertional tendinopathy presented with short tendons (3.8 ± 1.4 cm, p = <0.001) compared to those with longer free tendon length in mid-portion tendinopathy (5.9 ± 1.3 cm, p = <0.001). This anatomical distinction, along with the lower attachment of the soleus muscle, may contribute to differing biomechanical properties, influencing the risk of specific tendon pathologies.

CONCLUSIONS

This study is the first to report a higher prevalence of insertional tendinopathy and to highlight the link between short free tendon length and insertional tendinopathy. This emphasizes the importance of monitoring short free tendons, as they are likely pivotal in the development of insertional tendinopathy.

背景

跟腱病是运动员中常见的过度使用损伤，分为中部型和附着点型。虽然现有文献主要强调中部跟腱病是更常见的形式，但新出现的证据突出了附着点跟腱病的重要性。临床表现的差异值得进一步研究，特别是关于可能为治疗策略和康复方案提供依据的解剖学差异。

目的

本研究旨在评估跟腱病变的患病率，并探讨附着点型和中部型跟腱病之间游离肌腱长度的解剖学差异。

研究设计

本研究是一项横断面分析，是对跟腱病患者力学性能的一项更大规模纵向研究的一部分。

方法

从马耳他群岛各地招募了103名被诊断患有跟腱病变的患者（男性占38.8%，女性占61.2%，年龄：53±12.8岁，体重指数（BMI）：30±7.4kg/m²，60%久坐不动，40%有运动习惯），进行超声评估以测量肌腱长度并评估相关的解剖学特征。参与者根据跟腱病的类型进行分类。

结果

与中部跟腱病（20.3%）相比，附着点跟腱病的患病率更高（67.9%）。值得注意的是，与中部跟腱病中游离肌腱长度较长的参与者（5.9±1.3cm，p<0.001）相比，附着点跟腱病的参与者肌腱较短（3.8±1.4cm，p<0.001）。这种解剖学差异，以及比目鱼肌较低的附着点，可能导致生物力学特性不同，影响特定肌腱病变的风险。