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Achilles Tendinopathy

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Abstract

Achilles tendinopathy mainly arises from overuse, but is often present in middle-aged overweight patients with no history of increased physical activity [71]. Its natural history in patients who try and continue to exercise is of gradually increasing load-related localized pain coinciding with increased activity. Examination should include thorough inspection to assess for swelling and asymmetry of the involved tendons, range of motion testing, palpation for tenderness, and examination manoeuvres that simulate tendon loading and reproduce pain [125].

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References

  1. Alfredson H, Öhberg L (2005) Neovascularisation in chronic painful patellar tendinosis – promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatol Arthrosc 13:74–80

    Article  PubMed  Google Scholar 

  2. Alfredson H, Pietila T, Jonsson P et al (1998) Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 26:360–366

    CAS  PubMed  Google Scholar 

  3. Almekinders LC (1990) The efficacy of non-steroidal anti-inflammatory drugs in the treatment of ligament injuries. Sports Med 9:137–142

    Article  CAS  PubMed  Google Scholar 

  4. Almekinders LC, Temple JD (1998) Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 30:1183–90

    Article  CAS  PubMed  Google Scholar 

  5. Arndt AN, Komi PV, Bruggemann GP et al (1998) Individual muscle contributions to the in vivo achilles tendon force. Clin Biomech 13:532–541

    Article  Google Scholar 

  6. Astrom M (1997) On the nature and etiology of chronic achilles tendinopathy. PhD thesis, Lund University, Sweden.

    Google Scholar 

  7. Astrom M (1998) Partial rupture in Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand 69(4):404–407

    Article  CAS  PubMed  Google Scholar 

  8. Aström M, Westlin N (1992) No effect of piroxicam on Achilles tendinopathy. A randomized study of 70 patients. Acta Orthop Scand 63:631–634

    PubMed  Google Scholar 

  9. Bahr R, Fossan B, Løken S et al (2006) Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper’s knee). A randomized controlled trial. J Bone Joint Surg Am 88(8):1689–1698

    Google Scholar 

  10. Barnes SJ, Gey van Pettius D, Maffulli N (2003) Angioleiomyoma of the Achilles tendon. Bull Hosp Joint Dis 61(3–4): 137–139

    Google Scholar 

  11. Benazzo F, Maffulli N (2000) An operative approach to Achilles tendinopathy. Sports Med Arthrosc Rev 8:96–101

    Article  Google Scholar 

  12. Benjamin M, Ralphs J (1995) Functional and developmental anatomy of tendons and ligaments. In: Gordon SL, Blair SJ, Fine LJ (eds) Repetitive motion disorders of the upper extremity. American Academy of Orthopaedic Surgeons, Rosemont, IL, pp 185–203

    Google Scholar 

  13. Birkedal-Hansen H (1993) Role of matrix metalloproteinases in periodontal diseases. J Periodontol 64(5 suppl):474–484

    Google Scholar 

  14. Birkedal-Hansen H, Moore WGI, Bodden MK et al (1993) Matrix metalloproteinase: a review. Crit Rev Oral Biol Med 4:197–250

    CAS  PubMed  Google Scholar 

  15. Bleakley C, McDonough S, MacAuley D (2004) The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med 32:251–261

    Article  PubMed  Google Scholar 

  16. Brinckerhoff CE (1992) Regulation of metalloproteinase gene expression: implication for osteoarthritis. Crit Rev Euk Gene Expr 2:145–164

    CAS  Google Scholar 

  17. Casparian JM, Luchi M, Moffat RE et al (2000) Quinolones and tendon ruptures. South Med J 93:488–491

    CAS  PubMed  Google Scholar 

  18. Cawston TE, Billlington C (1996) Metalloproteinases in rheumatic diseases. J Pathol 180:115–117

    Article  CAS  PubMed  Google Scholar 

  19. Chan O, O’Dowd D, Padhiar N, Crisp T et al (2008) High volume image guided injections in chronic Achilles tendinopathy. Disabil Rehabil 30:1697–1708

    Article  PubMed  Google Scholar 

  20. Chandler S, Miller KM, Clements JM et al (1997) Matrix metalloproteinases, tumor necrosis factor and multiple sclerosis: an overview. J Neuroimmunol 72:155–161

    Article  CAS  PubMed  Google Scholar 

  21. Cook J, Bass S, Black J (2007) Hormone therapy is associated with smaller Achilles tendon diameter in active post-menopausal women. Scan J Med Sci Sports 17(2): 128–132

    CAS  Google Scholar 

  22. Cook JL, Khan KM, Kiss ZS, Griffiths L (2000) Patellar tendinosis in junior basketball players: a controlled clinical and ultrasonographic study of 268 tendons in players aged 4–18 years. Scand J Med Sci Sports10(4):216–230

    Article  CAS  PubMed  Google Scholar 

  23. Cook JL, Kiss ZS, Khan KM, Purdam CR, Webster KE (2004) Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross- sectional study. Br J Sports Med 38(2): 206–209

    Article  CAS  PubMed  Google Scholar 

  24. Crisp T, Khan F, Padhiar N, Chan O et al (2008) High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa’s body are effective in chronic patellar tendinopathy. Apilot study. Disabil Rehabil 30:1625–1634

    Article  Google Scholar 

  25. DaCruz DJ, Geeson M, Allen MJ et al (1988) Achilles paratendonitis: an evaluation of steroid injection. Br J Sports Med 22(2):64–65

    Article  CAS  PubMed  Google Scholar 

  26. Dalton S, Cawston TE, Riley GP et al (1995) Human shoulder tendon biopsy samples in organ culture produce procollagenase and tissue inhibitor of metalloproteinases. Ann Rheum Dis 54(7):571–577

    Article  CAS  PubMed  Google Scholar 

  27. Dayer JM, Burger D (1994) Interleukin-1, tumor necrosis factor and their specific inhibitors. Eur Cytokine Netw 5:563–571

    CAS  PubMed  Google Scholar 

  28. Ebinesan AD, Sarai BS, Walley GD et al (2008) Conservative, open or percutaneous repair for acute rupture of the Achilles tendon. Disabil Rehabil 30:1721–1725

    Article  PubMed  Google Scholar 

  29. Ferretti A (1986) Epidemiology of jumper’s knee. Sports Med 3(4):289–295

    Article  CAS  PubMed  Google Scholar 

  30. Ferretti A, Conteduca F, Camerucci E et al (2002) Patellar tendinosis. A follow-up study of surgical treatment. J Bone Joint Surg (Am) 84(12):2179–2185

    Google Scholar 

  31. Fredberg U, Pfeiffer-Jensen M, Stengaard Pederson K (2004) Ultrasonography as a tool for diagnosis, guidance of local steroid injection, and together with pressure algometry, monitoring of the treatment of athletes with jumper’s knee and chronic Achilles tendonitis: a randomized, double-blind, placebocontrolled study. Scand J Rheumatol 33: 94–101

    Article  CAS  PubMed  Google Scholar 

  32. Friedrich T, Schmidt W, Jungmichel D et al (2001) Histopathology in rabbit Achilles tendon after operative tenolysis (longitudinal fibre incisions). Scand J Med Sci Sports 11(1):4–8

    Google Scholar 

  33. Gomez DE, Alonso DF, Yoshiji H et al (1997) Tissue inhibitors of metalloproteinases: structure, regulation and biological functions. Eur J Cell Biol 74:111–122

    CAS  PubMed  Google Scholar 

  34. Goldberg GI, Eisen AZ (1991) Extracellular matrix metalloproteinases in tumor invasion and metastasis. Cancer Treat Res 53:421–440

    Google Scholar 

  35. Gomez DE, Alonso DF, Yoshiji H et al (1997) Tissue inhibitors of metalloproteinases: structure, regulation and biological functions. Eur J Cell Biol 74:111–122

    CAS  PubMed  Google Scholar 

  36. Goupille P, Jayson MIV, Valat J et al (1998) Matrix metalloproteinases: the clue to intervertebral disc degeneration? Spine 23(14):1612–1626

    Google Scholar 

  37. Green S, Buchbinder R, Barnsley L et al (2001) Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev (4):CD003686

    Google Scholar 

  38. Hamilton B, Remedios D, Loosemore M et al (2008) Achilles tendon rupture in an elite athlete following multiple injection therapies. J Sci Med Sport 11:566–568

    Google Scholar 

  39. Hess GP, Cappiello WL, Poole RM, Hunter SC (1989) Prevention and treatment of overuse tendon injuries. Sports Med 8:371–384

    Article  CAS  PubMed  Google Scholar 

  40. Ireland D, Harrall R, Curry V et al (2001) Multiple changes in gene expression in chronic human Achilles tendinopathy. Matrix Biol 20(3):159–169

    Article  CAS  PubMed  Google Scholar 

  41. James LJ, Ali K, Pocock C, Robertson C, Walter J, Bell J, Connel D (2007) US guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med 41:518–521

    Article  PubMed  Google Scholar 

  42. James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6(2):40–50

    Google Scholar 

  43. Jarvinen M, Jozsa L, Kannus P et al (1997) Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports 7(2):86–95

    Google Scholar 

  44. Jozsa L, Kannus P (1997) Human tendon: anatomy, physiology and pathology. Hum Kinet 100(3):289–317

    Google Scholar 

  45. Kader D, Saxena A, Movin T et al (2002) Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 36(4):239–249

    Article  CAS  PubMed  Google Scholar 

  46. Kaeding CC (2004) Surgical treatment of recalcitrant patellar tendinosis. Techniques Knee Surg 3(1):29–35

    Google Scholar 

  47. Kannus P, Jozsa L, Jarvinnen M (21) Basic science of tendons. In: Garrett WE, Jr SKP, Kirkendall DT (eds) Principles and practice of orthopaedic sports medicine. Lippincott Williams and Wilkins, Philadelphia, pp 37–2000

    Google Scholar 

  48. Kaufman K, Brodine S, Shaffer R, Johnson C, Cullison T (1999) The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 27(5):585–593

    Google Scholar 

  49. Khan KM, Cook JL, Maffulli N et al (2000) Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 34:81–83

    Article  CAS  PubMed  Google Scholar 

  50. Khan KM, Maffulli N (1998) Tendinopathy: an Achilles’ heel for athletes and clinicians. Clin J Sport Med 8:151–154

    Article  CAS  PubMed  Google Scholar 

  51. Kirkendall DT, Garrett WE (1997) Function and biomechanics of tendons. Scand J Med Sci Sports 7:62–66

    Article  CAS  PubMed  Google Scholar 

  52. Koskinen SOA, Heinemeier KM, Olesen JL et al (2004) Physical exercise can influence the levels of matrix metalloproteinases and their inhibitors in tendon related connective tissue. J Appl Physiol 96:861–864

    Article  CAS  PubMed  Google Scholar 

  53. Koskinen SOA, Höyhtyä M, Turpeemnniemi-Hujanen T et al (2001) Serum concentrations of collagen-degrading enzymes and their inhibitors after downhill running. Scand J Med Sci Sports 11:9–15

    Google Scholar 

  54. Kountouris A (2003) Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheum 21:295–316

    Article  Google Scholar 

  55. Kvist M (1991) Achilles tendon overuse injuries. PhD thesis, University of Turku, Finland

    Google Scholar 

  56. Kvist M, Jozsa L, Jarvinen MJ, Kvist H (1987) Chronic Achilles paratenonitis in athletes: a histological and histochemical study. Pathology 19:1–11

    Article  CAS  PubMed  Google Scholar 

  57. Kvist H, Kvist M (1980) The operative treatment of chronic calcaneal paratenonitis. J Bone Joint Surg (Br) 62:352–357

    Google Scholar 

  58. Langberg H, Skovgaard D, Petersen LJ et al (1999) Type I collagen synthesis and degradation in peritendinous tissue after exercise determined by microdialysis in humans. J Physiol 521 Pt 1:299–306

    Google Scholar 

  59. Leadbetter WB (1995) Anti-inflammatory therapy and sports injury: the role of non-steroidal drugs and corticosteroid injection. Clin Sports Med 14:353–410

    Google Scholar 

  60. Lippi G, Banfi G, Favaloro EJ et al (2008) Updates on improvement of human athletic performance: focus on world records in athletics. Br Med Bull 87:7–15

    Google Scholar 

  61. Longo UG, Franceschi F, Ruzzini L et al (2007) Light microscopic histology of supraspinatus tendon ruptures. Knee Surg Sports Traumatol Arthrosc 15(11):1390–1394

    Article  PubMed  Google Scholar 

  62. Longo UG, Franceschi F, Ruzzini L et al (2007) Light microscopic histology of supraspinatus tendon ruptures. Knee Surg Sports Traumatol Arthrosc 15:1390–1394

    Google Scholar 

  63. Longo UG, Franceschi F, Ruzzini L et al (2008) Histopathology of the supraspinatus tendon in rotator cuff tears. Am J Sports Med 36:533–538

    Google Scholar 

  64. Longo G, Ripalda P, Denaro V et al (2006) Morphologic comparison of cervical, thoracic, lumbar intervertebral discs of cynomolgus monkey (Macaca fascicularis). Eur Spine J 15:1845–1851

    Article  PubMed  Google Scholar 

  65. Lorentzon R (376) Cause of injuries: intrinsic factors. In: Dirix A, Knuttgen HG, Titel K (eds) The Olympic book of sports medicine. Blackwell Scientific, Boston, pp 390–1988

    Google Scholar 

  66. Lotz M, Gurene PA (1991) Interleukin-6 induces the synthesis of tissue inhibitor of metalloproteinase-1/ erythroid potentiating activity (TIMP-1/EPA). J Biol Chem 266:2017–2020

    CAS  PubMed  Google Scholar 

  67. Maffulli N, Ajis A, Longo UG et al (2007) Chronic rupture of tendo Achillis. Foot Ankle Clin 12(4):583–596

    Article  PubMed  Google Scholar 

  68. Maffulli N, Binfield PM, Moore D (1999) Surgical decompression of chronic central core lesions in the Achilles tendon. Am J Sports Med 27(6):747–752

    Google Scholar 

  69. Maffulli N, Kader D (2002) Tendinopathy of tendo achillis. J Bone Joint Surg Br 84(1):1–8

    Google Scholar 

  70. Maffulli N, Kenward MG, Testa V et al (2003) Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med 13(1):11–15

    Article  PubMed  Google Scholar 

  71. Maffulli N, Khan KM, Puddu G (1998) Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 14(8):840–843

    Article  CAS  PubMed  Google Scholar 

  72. Maffulli N, Reaper J, Ewen SW et al (2006) Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon. Clin J Sport Med 16(4):329–334

    Google Scholar 

  73. Maffulli N, Sharma P, Luscombe KL (2004) Achilles tendinopathy: aetiology and management. J R Soc Med 97(10):472–476

    Article  PubMed  Google Scholar 

  74. Maffulli N, Testa V, Capasso G, Oliva F, Regine R, King JB et al (2006) Surgery for chronic Achilles tendinopathy yields worse results in non-athletic patients. Clin J Sports Med 16(2):123–128

    Google Scholar 

  75. Maffulli N, Walley G, Sayana MK et al (2008) Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil 30:1677–1684

    Article  PubMed  Google Scholar 

  76. Mahieu NN, Witvrouw E, Stevens V et al (2006) Intrinsic risk factors for the development of Achilles tendon overuse injury. A prospective study. Am J Sports Med 34(2):226–235

    Article  PubMed  Google Scholar 

  77. Malliaras P, Cook J (2000) Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players. J Sci Med Sports 9(4):304–309

    Article  Google Scholar 

  78. Mauviel A (1993) Cytokine regulation of metalloproteinase gene expression. J Cell Biochem 53:288–295

    Article  CAS  PubMed  Google Scholar 

  79. McCarthy DA, Dale MM (1988) The leucocytosis of exercise. A review and model. Sports Med 6:333–363

    Google Scholar 

  80. Meikle MC, Hembry RM, Holley J et al (1994) Immunolocalization of matrix metalloproteinases and TIMP-1 in human gingival tissues from periodontitis patients. J Periodontol Res 29:118–126

    Article  CAS  Google Scholar 

  81. Mohr RN (1997) Achilles tendonitis: rationale for use and application of orthotics. Foot Ankle Clin 2:439–456

    Google Scholar 

  82. Mokone GG, Gajjar M, September AV et al (2005) The guanine-thymine dinucleotide repeat polymorphism within the tenascin-C gene is associated with Achilles tendon injuries. Am J Sports Med 33(7):1016–1021

    Article  PubMed  Google Scholar 

  83. Moore RA, Tramer MR, Carroll D et al (1998) Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs [published correction appears in BMJ 1998;316:1059]. BMJ 316:333–338

    Google Scholar 

  84. Movin T, Gad A, Reinholt FP et al (1997) Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand 68(2):170–175

    Article  CAS  PubMed  Google Scholar 

  85. Movin T, Kristoffersen-Wiberg M, Shalabi A, Gad A, Aspelin P, Rolf C (1998) Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in cronich achillodynia. Foot Ankle Int 19:311–317

    CAS  PubMed  Google Scholar 

  86. O’Brien M (1997) Structure and metabolism of tendons. Scand J Med Sci Sports 7:55–61

    Article  PubMed  Google Scholar 

  87. Oblander SA, Somerville RPT, Apte SS (2003) An update on metalloproteinases in the musculoskeletal system. Curr Opin Orthop 14:322–328

    Article  Google Scholar 

  88. Öhberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177

    Google Scholar 

  89. Öhberg L, Alfredson H (2004) Effects on neovascularisation behind the good results of eccentric training in chronic midportion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc 12:465–470

    Google Scholar 

  90. Öhberg L, Lorentzon L, Alfredson H (2004) Eccentric training in patients with chronic Achilles tendinosis: normalized tendon structure and decreased thickness at follow-up. Br J Sports Med 38:8–11

    Google Scholar 

  91. Paavola M, Kannus P, Orava S et al (2002) Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow-up study. Br J Sports Med 36(3):178–182

    Google Scholar 

  92. Paavola M, Orava S, Leppilahti J et al (2000) Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med 28(1):77–82

    Google Scholar 

  93. Perry J (1997) Achilles tendon anatomy. Foot Ankle Clin 2:363–370

    Google Scholar 

  94. Perugia L, Postacchini F, Ippolito E (1986) The tendons. Biology, pathology, clinical aspects. Editrice Kurtis s.r.l, Milano

    Google Scholar 

  95. Read MT (1999) Safe relief of rest pain that eases with activity in Achillodynia by intrabursal or peritendinous injection: The rupture rate was not increased by these steroid injections. Br J Sports Med 33:134–139

    Article  CAS  PubMed  Google Scholar 

  96. Richards PJ, Braid JC, Carmont MR et al (2008) Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil 30:1651–1665

    Google Scholar 

  97. Riley GP, Curry V, DeGroot J et al (2002) Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology. Matrix Biol 21:185–195

    Article  CAS  PubMed  Google Scholar 

  98. Riverburgh DW (1992) Physical modalities in the treatment of tendon injuries. Clin Sports Med 11:645–659

    Google Scholar 

  99. Robert V, Besse S, Sabri A et al (1997) Differential regulation of matrix metalloproteinases associated with aging and hypertension in the rat heart. Lab Invest 76:729–738

    CAS  PubMed  Google Scholar 

  100. Robinson JM, Cook JL, Purdam C et al (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341

    Google Scholar 

  101. Rolf C, Movin T (1997) Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int 118:565–569

    Google Scholar 

  102. Roos EM, Engstrom M, Lagerquist A et al (2004) Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy – a randomized trial with 1-year follow-up. Scand J Med Sci Sports 14:286–295

    Google Scholar 

  103. Royer RJ, Pierfitte C, Netter P (1994) Features of tendon disorders with fluoroquinolones. Therapie 49:75–76

    Google Scholar 

  104. Saarialho-Kere UK, Vaalamo M, Airola K et al (1995) Interstitial collagenase is expressed by keratinocytes that are actively involved in re-epithilialization in blistering skin diseases. J Invest Derm 104:982–988

    Article  CAS  PubMed  Google Scholar 

  105. Sayana MK, Maffulli N (2007) Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport 10:52–58

    Article  PubMed  Google Scholar 

  106. Schepsis AA, Leach RE (1987) Surgical management of Achilles tendinopathy. Am J Sports Med 15:308–315

    Article  CAS  PubMed  Google Scholar 

  107. Selvanetti A, Cipolla M, Puddu G (1997) Overuse tendon injuries: basic science and classification. Oper Tech Sports Med 5:110–117

    Article  Google Scholar 

  108. Silbernagel KG, Thomee R, Karlsson J (2005) Cross-cultural adaptation of the VISA-A questionnaire, an index of clinical severity for patients with Achilles tendinopathy, with reliability, validity and structure evaluations. BMC Musculoskelet Disord 6:12

    Article  PubMed  Google Scholar 

  109. Speed CA (2001) Corticosteroid injections in tendon lesions. BMJ 323:382–386

    Google Scholar 

  110. Stanish WD, Curwin S, Rubinovich M (1985) Tendinitis: the analysis and treatment for running. Sports Med Clin 4(4):593–609

    CAS  Google Scholar 

  111. Stanish WD, Rubinovich RM, Curwin S (1986) Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res (208):65–68

    Google Scholar 

  112. Stilwell DL, Jr (1957) The innervation of tendons and aponeuroses. Am J Anat 100:289–311

    Google Scholar 

  113. Tallon C, Coleman BD, Khan KM (2001) Outcome of surgery for chronic Achilles tendinopathy: a critical review. Am J Sports Med 29:315–320

    CAS  PubMed  Google Scholar 

  114. Tatari H, Kosay C, Ulukus C (2001) Effect of heparin on tendon degeneration: an experimental study on rats. Knee Surg Sports Traumatol Arthrosc 9:247–253

    Google Scholar 

  115. Testa V, Capasso G, Benazzo F et al (2001) Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exe 34:573–580

    Google Scholar 

  116. Tipton CM, Matthes RD, Maynard JA et al (1975) The influence of physical activity on ligaments and tendons. Med Sci Sports 7:165–175

    CAS  PubMed  Google Scholar 

  117. Tryggvason K, Hoyhtya M, Pyke C (1993) Type IV collagenases in invasive tumors. Breast Cancer Res Treat 24:209–218

    Google Scholar 

  118. Vailas AC, Pedrini VA, Pedrini-Mille A et al (1985) Patellar tendon matrix changes associated with aging and voluntary exercise. J Appl Physiol 58(5):1572–1576

    CAS  PubMed  Google Scholar 

  119. Vane JR (1996) Introduction: mechanism of action of NSAIDs. Br J Rheumatol 35:1–3

    Google Scholar 

  120. Visnes H, Bahr R (2007) The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med 41:217–223

    Article  PubMed  Google Scholar 

  121. Wang CJ, Ko JY, Chan YS et al (2007) Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med 35:972–978

    Article  PubMed  Google Scholar 

  122. Waterston SW, Maffulli N, Ewen SW (1997) Subcutaneous rupture of the Achilles tendon: basic science and some aspects of clinical practice. Br J Sports Med 31(4):285–298

    Google Scholar 

  123. Werb Z, Alexander CM, Adler RR (1992) Expression and function of matrix metalloproteinases in development. In: Birkedal-Hansen H, Werb Z, Welgus HG et al (eds) Matrix metalloproteinases and inhibitors. Stuttgart (Germany) 7 Gustav Fischer, pp 337–343

    Google Scholar 

  124. Williams JG (1986) Achilles tendon lesions in sport. Sports Med 3(2):114–135

    Google Scholar 

  125. Wilson JJ, Thomas M et al (2005) Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician 72:811–818

    PubMed  Google Scholar 

  126. Winge S, Jorgensen U, Lassen Nielsen A (1989) Epidemiology of injuries in Danish championship tennis. Int J Sports Med 10(5):368–371

    Article  CAS  PubMed  Google Scholar 

  127. Wright JK, Cawston TE, Hazleman BL (1991) Transforming growth factor b stimulates the production of the tissue inhibitor of metalloproteinase by human synovial and skin fibroblasts. Biochem Biophys Acta 1094:207–210; metalloproteases in tendinopathy 275

    Google Scholar 

  128. Yasuda T, Poole AR, Shimizu M et al (2003) Involvement of CD44 in induction of matrix metalloproteinases by a COOH-terminal heparin-binding fragment of fibronectin in human articular cartilage in culture. Arthritis Rheum 48(5):1271–1280

    Google Scholar 

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Maffulli, N., Oliva, F. (2010). Achilles Tendinopathy. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 10. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11832-6_17

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