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Orthobiologics for the Treatment of Achilles Tendinopathy

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Orthobiologics

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Abstract

Achilles tendinopathy (AT) is a chronic degenerative process that can occur at its insertion on the calcaneus or midsubstance. Presenting signs and symptoms include pain and swelling over a region of nodular tendon thickening. Biologic therapies for AT aim to restore the properties of the native tendon, thereby reducing pain, improving function, and reducing the risk of rupture. Biologic therapies may help facilitate a more robust healing response compared to other commonly used nonsurgical treatment modalities, thereby resulting in a tendon with biomechanical properties that are more similar to the native uninjured tendon. These therapies may also have a role as an adjuvant treatment in the surgical setting. Several different types of injectable biologic therapies have been described including corticosteroids, autologous blood products, platelet-rich plasma, sodium hyaluronate, and cell-based solutions. The role of cell-based therapies continues to evolve and includes peripheral blood mononuclear cells, bone marrow aspirate concentrate, and culture-expanded cells including mesenchymal stromal cells and adipose-derived stromal cells. This chapter specifically focuses on injectable biologic therapies for Achilles tendon pathology. While the main focus will be on AT, results of injectable biologics in the setting of Achilles tendon repair will be briefly discussed. Based on currently available evidence, no definite treatment recommendations can be made, and biologic therapies should be used judiciously, tailoring the treatment to the needs of the patient while setting appropriate expectations for treatment outcomes.

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Authors and Affiliations

  1. Department of Orthopaedics, Emory University School of Medicine, Flowery Branch, GA, USA

    Joseph D. Lamplot

  2. Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

    Cort D. Lawton

  3. OrthoIllinois, Algonquin, IL, USA

    Scott A. Rodeo

Authors
  1. Joseph D. Lamplot
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  2. Cort D. Lawton
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  3. Scott A. Rodeo
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Correspondence to Joseph D. Lamplot .

Editor information

Editors and Affiliations

  1. Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

  2. Orthopaedic & Sports Medicine Group, Santa Monica Orthopaedic & Sports Medicine, Santa Monica, CA, USA

    Bert R. Mandelbaum

  3. Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    George F. Muschler

  4. Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

  5. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

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Lamplot, J.D., Lawton, C.D., Rodeo, S.A. (2022). Orthobiologics for the Treatment of Achilles Tendinopathy. In: Filardo, G., Mandelbaum, B.R., Muschler, G.F., Rodeo, S.A., Nakamura, N. (eds) Orthobiologics. Springer, Cham. https://doi.org/10.1007/978-3-030-84744-9_18

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