[Insertional Achilles tendinopathy : Differentiated diagnostics and therapy].

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation

Background:

• Achilles tendinopathy at the calcaneal insertion encompasses insertional tendinopathy, retrocalcaneal bursitis, and superficial bursitis.
• Understanding current evidence on conservative and surgical interventions is crucial for effective patient management.

Purpose of the Study:

• To present current evidence on conservative and surgical treatment options for insertional Achilles tendinopathy.
• To evaluate the efficacy and safety of various therapeutic approaches.

Main Methods:

• Review of current evidence on conservative therapies including activity modification, NSAIDs, footwear adaptation, orthoses, immobilization, eccentric exercises, and extracorporeal shock wave therapy.
• Analysis of surgical interventions such as open debridement and tendoscopy, including indications and outcomes.
• Assessment of evidence for injections like platelet-rich plasma (PRP), dextrose, and polidocanol.

Main Results:

• Conservative therapies like eccentric exercises (40% pain reduction) and extracorporeal shock wave therapy (60% pain reduction, 80% satisfaction) show significant efficacy.
• Surgical debridement has a >70% success rate but up to 40% complication rate; indicated after 6 months of failed conservative treatment.
• Injections (PRP, dextrose, polidocanol) lack sufficient evidence for recommendation; tendoscopy is promising for isolated retrocalcaneal bursitis with lower complication rates than open debridement.

Conclusions:

• Conservative management, particularly eccentric exercises and shock wave therapy, should be prioritized for insertional Achilles tendinopathy.
• Surgical intervention is reserved for refractory cases, with open debridement and tendoscopy offering different risk-benefit profiles.
• Further research is needed to establish the role of regenerative therapies and specific surgical techniques.