PST  Vol.2 No.2 , April 2014
Successful Painful Treatment of the Painful Achilles Was the Start for Research Providing New Knowledge about Tendon Pain and New Treatment Methods
Author(s) Håkan Alfredson*
ABSTRACT

Successful treatment with painful eccentric training for patients with chronic painful midportion Achilles tendinosis started research on pain mechanisms involving ultrasound + Doppler investigations and immunohistochemical analyses of tendon tissue specimens. This research has resulted in a better understanding of the pain mechanisms involved in the chronic painful Achilles and patellar tendon, and based on these findings new non tendon-invasive treatment methods beneficial for the patients have been invented. This is a mini review showing the background and research that resulted in the highly successful mini surgical treatments for mid-portion Achilles tendinopathy and proximal patellar tendinopathy.


Cite this paper
Alfredson, H. (2014) Successful Painful Treatment of the Painful Achilles Was the Start for Research Providing New Knowledge about Tendon Pain and New Treatment Methods. Pain Studies and Treatment, 2, 79-85. doi: 10.4236/pst.2014.22013.
References
[1]   Alfredson, H., Pietil?, T., Jonsson, P. and Lorentzon, R. (1998) Heavy-Loaded Eccentric Calf-Muscle Training for the Treatment of Chronic Achilles Tendinosis. American Journal of Sports Medicine, 26, 360-366.

[2]   Mafi, N., Lorentzon, R. and Alfredson, H. (2001) Superior Results with Eccentric Calf-Muscle Training Compared to Concentric Training in a Randomized Prospective Multi-Center Study on Patients with Chronic Achilles Tendinosis. Knee Surgery, Sports Traumatology, Arthroscopy, 9, 42-47. http://dx.doi.org/10.1007/s001670000148

[3]   Fahlstr?m, M., Jonsson, P., Lorentzon, R. and Alfredson, H. (2003) Chronic Achilles Tendon Pain Treated with Eccentric Calf-Muscle Training. Knee Surgery, Sports Traumatology, Arthroscopy, 11, 327-333. http://dx.doi.org/10.1007/s00167-003-0418-z

[4]   ?hberg, L., Lorentzon, R. and Alfredson, H. (2004) Eccentric Training in Patients with Chronic Achilles Tendinosis- Normalized Tendon Structure and Decreased Thickness at Follow-Up. British Journal of Sports Medicine, 38, 8-11. http://dx.doi.org/10.1136/bjsm.2001.000284

[5]   ?hberg, L., Lorentzon, R. and Alfredson, H. (2001) Neovsacularisation in Achilles Tendons with Painful Tendinosis but Not in Normal Tendons: An Ultrasonographic Investigation. Knee Surgery, Sports Traumatology, Arthroscopy, 9, 233-238. http://dx.doi.org/10.1007/s001670000189

[6]   Alfredson, H., ?hberg, L. and Forsgren, S. (2003) Is Vasculo-Neural in Growth the Cause of Pain in Chronic Achilles Tendinosis?―An Investigation Using Ultrasonogrphy and Colour Doppler, Immunohistochemistry, and Diagnostic Injections. Knee Surgery, Sports Traumatology, Arthroscopy, 11, 334-338. http://dx.doi.org/10.1007/s00167-003-0391-6

[7]   Andersson, G., Danielson, P., Alfredson, H. and Forsgren, S. (2007) Nerve-Related Characteristics of Ventral Paratendinous Tissue in Chronic Achilles Tendinosis. Knee Surgery, Sports Traumatology, Arthroscopy, 15, 1272-1279. http://dx.doi.org/10.1007/s00167-007-0364-2

[8]   Danielsson, P., Andersson, G., Alfredson, H. and Forsgren, S. (2008) Marked Sympathetic Component in the Perivascular Innervation of the Dorsal Paratendinous Tissue of the Patellar Tendon in Arthroscopically Treated Tendinosis Patients. Knee Surgery, Sports Traumatology, Arthroscopy, 16, 621-626. http://dx.doi.org/10.1007/s00167-008-0530-1

[9]   ?hberg, L. and Alfredson, H. (2002) Ultrasound Guided Sclerosing of Neovessels in Painful Chronic Achilles Tendinosis: Pilot Study of a New Treatment. British Journal of Sports Medicine, 36, 173-177. http://dx.doi.org/10.1136/bjsm.36.3.173

[10]   Alfredson, H. and ?hberg, L. (2005) Sclerosing Injections to Areas of Neovascularisation Reduce Pain in Chronic Achilles Tendinopathy: A Double-Blind Randomized Controlled Trial. Knee Surgery, Sports Traumatology, Arthroscopy, 13, 338-344. http://dx.doi.org/10.1007/s00167-004-0585-6

[11]   Lind, B., ?hberg, L. and Alfredson, H. (2006) Sclerosing Polidocanol Injections in Mid-Portion Achilles Tendinosis: Remaining Good Clinical Results and Decreased Tendon Thickness at 2-Year Follow-Up. Knee Surgery, Sports Tra- umatology, Arthroscopy, 14, 1327-1332. http://dx.doi.org/10.1007/s00167-006-0161-3

[12]   Alfredson, H. and ?hberg, L. (2005) Neovascularisation in Chronic Painful Patellar Tendinosis Promising Results after Sclerosing Neovessels outside the Tendon Challenges the Need for Surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 13, 74-80. http://dx.doi.org/10.1007/s00167-004-0549-x

[13]   Hoksrud, A., ?hberg, L., Alfredson, H. and Bahr, R. (2006) Ultrasound-Guided Sclerosis of Neovessels in Painful Chronic Patellar Tendinopathy―A Randomized Controlled Trial. American Journal of Sports Medicine, 34, 1738- 1746. http://dx.doi.org/10.1177/0363546506289168

[14]   Alfredson, H., ?hberg, L., Zeisig, E. and Lorentzon, R. (2007) Treatment of Midportion Achilles Tendinosis: Similar Clinical Results with US and CD-Guided Surgery outside the Tendon and Sclerosing Polidocanol Injections. Knee Surgery, Sports Traumatology, Arthroscopy, 15, 1504-1509. http://dx.doi.org/10.1007/s00167-007-0415-8

[15]   Alfredson, H. (2011) Ultrasound and Doppler-Guided Mini-Surgery to Treat Midportion Achilles Tendinosis: Results of a Large Material and a Randomised Study Comparing two Scraping Techniques. British Journal of Sports Medicine, 45, 407-410. http://dx.doi.org/10.1136/bjsm.2010.081216

[16]   Alfredson, H. (2011) Midportion Achilles Tendinosis and the Plantaris Tendon. British Journal of Sports Medicine, 45, 1023-1025. http://dx.doi.org/10.1136/bjsports-2011-090217

[17]   Spang, C., Alfredson, H., Ferguson, M., Roos, B., Bagge, J. and Forsgren, S. (2013) The Plantaris Tendon in Associa- tion with Midportion Achilles Tendinosis: Tendinosis-Like Morphological Features and Presence of a Non-Neuronal Cholinergic System. Histology and Histopathology, 28, 623-632.

[18]   Willberg, L., Sunding, K., Forsblad, M. and Alfredson, H. (2007) Ultrasound- and Doppler-Guided Arthroscopic Shaving to Treat Jumper’s Knee. Knee Surgery, Sports Traumatology, Arthroscopy, 15, 1400-1403. http://dx.doi.org/10.1007/s00167-007-0360-6

[19]   Willberg, L., Sunding, K., Forssblad, M., Fahlstrom, M. and Alfredson, H. (2011) Sclerosing Polidocanol Injections or Arthroscopic Shaving to Treat Patellar Tendinopathy/Jumper’s Knee? A Randomised Controlled Study. British Jour- nal of Sports Medicine, 45, 411-415. http://dx.doi.org/10.1136/bjsm.2010.082446

[20]   Leadbetter, W.B., Mooar, P.A., Lane, G.J. and Lee, S.J. (1992) The Surgical Treatment of Tendinitis. Clinical Ratio- nale and Biologic Basis. Clinics in Sports Medicine, 11, 679-712

[21]   Nelen, G., Martens, M. and Burssens, A. (1989) Surgical Treatment of Chronic Achilles Tendinitis. American Journal of Sports Medicine, 17, 754-759. http://dx.doi.org/10.1177/036354658901700605

[22]   Tallon, C., Coleman, B.D., Khan, K.M. and Maffulli, N. (2001) Outcome of Surgery for Chronic Achilles Tendinopathy. A Critical Review. American Journal of Sports Medicine, 29, 315-320.

[23]   Alfredson, H., Zeisig, E. and Fahlstr?m, M. (2009) No Normalisation of the Tendon Structure and Thickness after Intra- Tendinous Surgery for Chronic Painful Midportion Achilles Tendinosis. British Journal of Sports Medicine, 43, 948- 949. http://dx.doi.org/10.1136/bjsm.2008.050955

[24]   ?str?m, M. (1997) On the Nature and Etiology of Chronic Achilles Tendinopathy. Dissertation, University of Lund, Lund.

[25]   Danielsson, P., Alfredson, H. and Forsgren, S. (2006) Immunohistochemical and Histochemical Findings Favoring the Occurrence of Autocrine/Paracrine as Well as Nerve-Related Cholinergic Effects in Chronic Painful Patellar Tendon Tendinosis. Microscopy Research and Technique, 69, 808-819. http://dx.doi.org/10.1002/jemt.20351

[26]   Danielson, P., Alfredson, H. and Forsgren, S. (2007) Studies on the Importance of Sympathetic Innervation, Adrener- gic Receptors, and a Possible Local Catecholamine Production in the Development of Patellar Tendinopathy (Tendino- sis) in Man. Microscopy Research and Technique, 80, 2235-2238.

[27]   Danielson, P., Andersson, G., Alfredson, H. and Forsgren, S. (2007) In Situ Hybridization Studies Confirming Recent Findings of the Existence of a Local Non-Neuronal Catecholamine Production in Human Patellar Tendinosis. Microscopy Research and Technique, 70, 908-911. http://dx.doi.org/10.1002/jemt.20495

[28]   Bjur, D., Danielsson, P., Alfredson, H. and Forsgren, S. (2008) Immunohistochemical and in Situ Hybridization Ob- servations Favour a Local Catecholamine Production in the Human Achilles Tendon. Histology and Histopathology, 23, 197-208.

[29]   Bjur, D., Danielson, P., Alfredson, H. and Forsgren, S. (2008) Presence of a Non-Neuronal Cholinergic System and Occurrence of Up- and Down Regulation in Expression of M2 Muscarinic Acetylcholine Receptors: New Aspects of Importance Regarding Achilles Tendon Tendinosis (Tendinopathy). Cell and Tissue Research, 331, 385-400. http://dx.doi.org/10.1007/s00441-007-0524-1

[30]   Andersson, G., Danielsson, P., Alfredson, H. and Forsgren, S. (2008) Presence of Substance P and the Neurokinin-1 Receptor in Tenocytes of the Human Achilles Tendon. Regulatory Peptides, 150, 81-87. http://dx.doi.org/10.1016/j.regpep.2008.02.005

 
 
Top