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Traweger A, Scott A, Kjaer M, Wezenbeek E, Scattone Silva R, Kennedy JG, Butler JJ, Gomez-Florit M, Gomes ME, Snedeker JG, Dakin SG, Wildemann B. Achilles tendinopathy. Nat Rev Dis Primers 2025; 11:20. [PMID: 40148342 DOI: 10.1038/s41572-025-00602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2025] [Indexed: 03/29/2025]
Abstract
Achilles tendon pathologies are prevalent, impacting ~6% of the general population and up to 50% of elite endurance runners over their lifetimes. These conditions substantially affect quality of life and work productivity, leading to substantial societal costs. Achilles tendinopathy (AT) is a condition marked by localized pain and functional impairment related to mechanical loading. AT can considerably impair participation and potentially also performance in sports and daily activities. The aetiology of AT is multifactorial and repetitive overloading of the tendon is often observed as the inciting factor by health professionals. However, AT can also be associated with adverse effects of certain medication, ageing and various comorbidities. Characteristic tendon changes include proteoglycan accumulation, fluid accumulation with swelling and hypervascularization. Tissue disorganization advances as pathological changes in matrix structure are driven by altered cellular function and makeup, often accompanied by persistent inflammation. Treatment strategies include various interventions, although these can be protracted and challenging for both patients and health-care providers, often with high failure rates. Current research focuses on understanding the pathological processes at the cellular and molecular levels to distinguish between disease categories and to investigate the role of inflammation, metabolic maladaptation and mechanical stress. Emerging therapeutic approaches need to be developed to address these underlying mechanisms. These approaches focus on optimizing rehabilitation protocols and advancing the development of adjunct therapies, such as advanced therapy medicinal products, alongside the integration of precision medicine to improve treatment outcomes.
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Affiliation(s)
- Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, Salzburg, Austria.
| | - Alex Scott
- Department of Physical Therapy, Centre for Aging SMART, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Evi Wezenbeek
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rodrigo Scattone Silva
- Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - John G Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - James J Butler
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Manuel Gomez-Florit
- Health Research Institute of the Balearic Islands (IdISBa), Research Unit Son Espases University Hospital (HUSE), Palma, Spain
- Group of Cell Therapy and Tissue Engineering (TERCIT), Research Institute on Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Spain
| | - Manuela E Gomes
- School of Medicine and Biomedical Sciences (ICBAS), Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Jess G Snedeker
- Department of Orthopaedics, Balgrist, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
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Zhang X, Li M, Mao X, Yao Z, Zhu W, Yuan Z, Gao X, Pan S, Zhang Y, Zhao J, Mao H. Small Intestinal Submucosa Hydrogel Loaded With Gastrodin for the Repair of Achilles Tendinopathy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2401886. [PMID: 39185812 DOI: 10.1002/smll.202401886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 08/05/2024] [Indexed: 08/27/2024]
Abstract
Achilles tendinopathy (AT) is an injury caused by overuse of the Achilles tendon or sudden force on the Achilles tendon, with a considerable inflammatory infiltrate. As Achilles tendinopathy progresses, inflammation and inflammatory factors affect the remodeling of the extracellular matrix (ECM) of the tendon. Gastrodin(Gas), the main active ingredient of Astrodia has anti-inflammatory, antioxidant, and anti-apoptotic properties. The small intestinal submucosa (SIS) is a naturally decellularized extracellular matrix(dECM)material and has a high content of growth factors as well as good biocompatibility. However, the reparative effects of SIS and Gas on Achilles tendinopathy and their underlying mechanisms remain unknown. Here, it is found that SIS hydrogel loaded with gastrodin restored the mechanical strength of the Achilles tendon, facilitated ECM remodeling, and restored ordered collagen arrangement by promoting the translocation of protein synthesis. It also decreases the expression of inflammatory factors and reduces the infiltration of inflammatory cells by inhibiting the NF-κB signaling pathway. It is believed that through further research, Gas + SIS may be used in the future for the treatment of Achilles tendinopathy and other Achilles tendon injury disorders.
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Affiliation(s)
- Xiqian Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Mei Li
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Xufeng Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Zheyu Yao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Weilai Zhu
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, P. R. China
| | - Zheyang Yuan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Xiang Gao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
| | - Senghao Pan
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, P. R. China
| | - Yijun Zhang
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, P. R. China
| | - Jiyuan Zhao
- Zhejiang Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, P. R. China
| | - Haijiao Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, P. R. China
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Butler JJ, Randall GW, Schoof L, Roof M, Weiss MB, Gianakos AL, Kennedy JG. Excellent Clinical Outcomes and Rapid Return to Activity Following In-Office Needle Tendoscopy for Chronic Achilles Tendinopathy. Arthrosc Sports Med Rehabil 2024; 6:100937. [PMID: 39006796 PMCID: PMC11240018 DOI: 10.1016/j.asmr.2024.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Abstract
PURPOSE To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up. METHODS A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment-Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. RESULTS Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment-Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9. CONCLUSIONS This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- James J. Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Grace W. Randall
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Lauren Schoof
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Mackenzie Roof
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Matthew B. Weiss
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
| | - Arianna L. Gianakos
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
- Department of Orthopaedic Surgery, Yale Medicine Orthopaedics and Rehabilitation, New Haven, Connecticut, U.S.A
| | - John G. Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, New York, U.S.A
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Fariyike B, Neal WH, Bi AS, Owusu-Sarpong S, Colasanti CA, Kirschner N, Azam MT, Butler JJ, Stone JW, Kennedy JG. In-Office Needle Arthroscopy for Superior Labral Tear Debridement. Arthrosc Tech 2024; 13:102956. [PMID: 38835456 PMCID: PMC11144941 DOI: 10.1016/j.eats.2024.102956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
SLAP tears are a common cause of shoulder pain in overhead athletes. The benefits of in-office nano-arthroscopy include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced health care costs, and improved patient satisfaction. This technique can be particularly advantageous in the management of SLAP tears given that magnetic resonance imaging has poor sensitivity without the use of an invasive arthrogram. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for SLAP tears with special consideration of the technique for obtaining adequate local anesthesia, proper indications, and adequate visualization, as well as the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
- Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | | | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James J. Butler
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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Colasanti CA, Azam MT, Bi AS, Fariyike B, Kirschner N, Neal WH, Owusu-Sarpong S, Stone JW, Kennedy JG. Reproducible and Effective Biceps Tenodesis Method Utilizing In-Office Nano-Arthroscopy. Arthrosc Tech 2023; 12:e1797-e1802. [PMID: 37942114 PMCID: PMC10628057 DOI: 10.1016/j.eats.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
Biceps tendinopathy is a common cause of chronic anterior shoulder pain characterized by altered joint mechanics with considerable deficits in range of motion secondary to pain. The benefits of in-office nano-arthroscopy (IONA) include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing IONA for biceps tendinopathy (biceps tenotomy/biceps tenodesis), with special consideration for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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Owusu-Sarpong S, Fariyike B, Colasanti CA, Bi AS, Kirschner N, Neal WH, Azam MT, Stone JW, Kennedy JG. In-Office Nano-Arthroscopy of the Shoulder with Acromioplasty. Arthrosc Tech 2023; 12:e1423-e1428. [PMID: 37654871 PMCID: PMC10466288 DOI: 10.1016/j.eats.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Subacromial decompression with acromioplasty is among the most commonly performed shoulder procedures. The advantages of in-office nano-arthroscopy include the capability of diagnosing and treating subacromial impingement, swifter patient recovery, improved cost-effectiveness, and superior patient satisfaction. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for subacromial decompression (subacromial bursectomy and acromioplasty), with a particular focus on appropriate indications, providing sufficient local anesthesia, optimizing visualization, and discussing the advantages of the in-office setting compared to the operating room.
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Affiliation(s)
| | | | | | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
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Needle arthroscopy in anatomical reconstruction of the lateral ankle: a report of three cases with a parallel comparison to the standard arthroscopy procedure. J Exp Orthop 2022; 9:75. [PMID: 35907091 PMCID: PMC9339066 DOI: 10.1186/s40634-022-00510-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study evaluates the use of the needle arthroscopy in anatomical reconstruction of the lateral ankle. We hypothesized that the needle arthroscopy would allow anatomical reconstruction to be performed under arthroscopy. Methods Three patients underwent treatment of chronic ankle instability. The comparative procedure was performed in the following four steps: 1) anteromedial articular exploration (medial/lateral gutter/anterior chamber/syndesmosis); 2)creation of the talar tunnel via the anteromedial arthroscopic approach; 3) anterolateral fibular tunneling; and 4) positioning of the graft by the anteromedial arthroscopic approach. For each of these steps, the planned procedure using the needle arthroscope was compared to the standard arthroscope. For each step, the planned procedure using the needle arthroscopy was compared to the standard arthroscope and the act was classified based on level of difficulty: facilitated, similar, complicated and impossible. Results The exploration of the medial and lateral gutter, the creation of the tunnel of the talus and graft positioning were not accomplished using the needle arthroscope. While the syndesmosis visualization was facilitated by the needle arthroscope in comparison to the standard arthroscope. Conclusion The anatomical reconstruction of the lateral ankle, using the needle arthroscopy-only approach, was impossible in all three cases, regarding: ankle joint exploration, creation of the tunnel of the talus and graft positioning. The needle arthroscope should not be considered as a "mini arthroscope" but as a new tool with which it is necessary to rethink procedures to take advantage of the benefits of this instrument.
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