Achilles tendon ailments : clinical and biological aspects
This thesis reports studies on the epidemiology, pathology, biochemistry, imaging and management of Achilles tendon ailments. Ultrasonography is a sensitive tool to diagnose Achilles tendinopathy and Achilles tendon rupture (ATR), and to follow its healing non-invasively. Muscle fibre composition of the triceps surae does not show significant association with ATR. In patients with a suspected ATR, when two of the commonly used clinical tests are positive for a rupture, an ATR can confidently be diagnosed. The association between ATR and sciatica was investigated by questionnaire in patients who underwent repair of an ATR, and in individuals nominated by the patients, matched for age, sex and occupation. Although the two groups were well matched, 35% of the patients and 12% of the controls had experienced sciatic pain prior to rupture. This association could be due to impaired afferent signals from the lower leg, or to similar collagen or vascular anomalies of the vertebral disc and of the Achilles tendon. A reproducible rat model of acute Achilles tendinopathy was created, and the effects of pulsed electromagnetic fields examined. Some frequencies of pulsed electromagnetic fields result in better collagen fibre alignment following injury. Growth factors in an in vitro rat tendon healing model result in faster healing following wounding, and their possible application in clinical practice is exciting. A minimally invasive procedure for the management of chronic tendinopathy shows that such approach gives a good chance of success when paratendinopathy is not present. A technique of open repair of ATR is presented, and the results in a group of 47 patients reported, and the rationale of management of patients with an ATR is detailed. Finally, the incidence of ATR in Scotland over a 15 year period has been studied: the condition has become significantly more common since 1986.