Differences at the Achilles Insertion Between Adults with Insertional and Midportion Achilles Tendinopathy as...

Area of Science:

• Orthopedics
• Sports Medicine
• Musculoskeletal Imaging

Background:

• Achilles tendinopathy is a common condition affecting athletes and active individuals.
• Two primary forms exist: insertional Achilles tendinopathy (IAT) and midportion Achilles tendinopathy (MidAT).
• Understanding structural differences between IAT and MidAT is crucial for targeted treatment.

Purpose of the Study:

• To investigate and compare structural and pathological differences at the Achilles tendon insertion.
• The study focused on differentiating between IAT and MidAT in both injured and uninjured tendons.
• This aims to identify unique characteristics of each tendinopathy type.

Main Methods:

• A cohort of 34 patients with unilateral Achilles tendinopathy (50% IAT, 50% MidAT) was analyzed.
• Ultrasound imaging assessed structural parameters: insertion length, bone-to-insertion length, tendon angle, overall tendon length, and thickness at the calcaneal edge.
• Pathological changes like boney deformity and calcification were also evaluated using a 2x2 mixed ANOVA.

Main Results:

• Significantly greater tendon thickness at the calcaneus was observed on the injured side in the IAT group compared to the uninjured side (P=.001).
• No significant difference in calcaneal edge tendon thickness was found between injured and uninjured sides in the MidAT group.
• No significant group-by-side interactions were detected for other measured structural parameters at the insertion site.

Conclusions:

• Increased calcaneal edge tendon thickness is a distinguishing structural feature of insertional Achilles tendinopathy (IAT) on the injured side.
• This specific structural alteration was not observed in patients with midportion Achilles tendinopathy (MidAT).
• These findings suggest distinct underlying pathologies for IAT and MidAT, impacting treatment strategies.