Rheumatology: Current Research
Open Access
ISSN: 2161-1149 (Printed)
ISSN: 2161-1149 (Printed)
Sture Forsgren, H�kan Alfredson and Christoph Spang
Scientific Tracks Abstracts: Rheumatology & Orthopedics
I t is frequently observed that midportion Achilles tendinopathy/tendinosis occurs bilaterally. With this as a background, the outcome of unilateral operations was evaluated for 13 patients with chronic painful bilateral midportion Achilles tendinopathy (tendinosis) (duration: 6-120 months). Seven of these were males and 6 were women. Prolonged periods of rest had had no effect. As surgical treatment, an ultrasound and Doppler-guided scraping procedure outside the ventral part of the tendon was performed in local anaestesia, a method that has been found to be effective for the great majority of Achilles tendinosis patients. The surgical treatment was made only on one side, the other side being left un-treated. The patients started walking on the first day after surgery. Follow-ups were made. In an additional part of the study, specimens from Achilles and plantaris tendons in 3 patients with bilateral Achilles tendinosis, were examined. Follow-ups showed postoperative improvement also on the non- operated side in 11/13 patients, and final follow up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2/13 patients, operation on also the other, initially non-operated side, was needed. Morphologically, it was found that there were similar morphological characteristics and similar immunohistochemical pattern concerning enzyme involved in signal substance production bilaterally, the microscopic findings being in line with previous information for tendinosis tendons. It can be concluded that the structural affections are similar on both sides in bilateral Achilles tendinosis. The study shows importantly that unilateral operative treatment can have benefits also contralaterally. It is not likely that this is related to rest postoperatively for the non-operated tendon. A hypothesis instead is that unilateral influences on the sensory innervation in the peritendinous tissue in response to the scraping operation has secondary effects contralaterally. I.e. influences on the pattern of primary-afferent activation on one side can have effects contralaterally. The interpreation concerning a presumable cross-talk between right and left sides are in line with the results of recent experimental studies in animals showing that tendinosis-like features occur bilaterally in the Achilles tendons in response to unilateral overuse, suggesting that there is an involvement of central neuronal mechanisms. The observations of bilateral effects in response to unilateral treatment have clinical implications.
Sture Forsgren is Professor in Anatomy at the Department of Integrative Medical Biology, Ume� University, Ume�, Sweden. He received his MD 1974 and completed his PhD 1982. His research has been devoted to several aspects on the human body. Main focus has been on muscle tendons, joints and heart muscle. He has participated in numerous conferences and served as reviewer in various fields of signal substance research. He has published 140 scientific articles, the overwhelming majority being peer-reviewed articles