| 31. |
- Alfredson, Håkan
(författare)
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Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy
- 2015
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Ingår i: Revista Brasileira de Fisioterapia. - : FapUNIFESP (SciELO). - 1413-3555 .- 1809-9246. ; 19:5, s. 429-432
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.
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| 32. |
- Alfredson, Håkan, et al.
(författare)
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Clinical presentation and surgical management of chronic Achilles tendon disorders : a retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon
- 2018
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Ingår i: Foot and Ankle Surgery. - : Elsevier. - 1268-7731 .- 1460-9584. ; 24:6, s. 490-494
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Tidskriftsartikel (refereegranskat)abstract
- Background: Non-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups.Aims: To study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders.Material and methods: One surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment - Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database.Results: Clinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications.Conclusions: Patients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent.
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| 33. |
- Alfredson, Håkan, et al.
(författare)
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Concentric and eccentric shoulder and elbow muscle strength in female volleyball players and non-active females
- 1998
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 8:5 Pt 1, s. 265-270
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Tidskriftsartikel (refereegranskat)abstract
- Maximal isokinetic concentric (60 degrees/s and 180 degrees/s) and eccentric (60 degrees/s) muscle strength of the external and internal rotator muscles of the shoulder and the flexor and extensor muscles of the elbow was measured in a position resembling spiking and serving in volleyball, on 11 non-injured female volleyball players (first division) and 11 non-active females. In the dominant arm, the volleyball players had significantly higher concentric peak torque of the internal and external rotators and elbow extensors at both velocities, and significantly higher eccentric peak torque of the shoulder internal and external rotators and elbow flexors and extensors, than the controls. In the volleyball group, the concentric internal rotation peak torque at 60 degrees/s was significantly higher in the dominant than in the non-dominant arm. The external/internal strength ratio was significantly lower at 60 degrees/s, but not at 180 degrees/s, in the dominant arm. CONCLUSION: The female volleyball players had a higher concentric and eccentric strength in the rotator muscles of the shoulder and in the extensor muscles of the elbow compared to untrained controls in this special test position. There were signs of rotator muscle imbalance at the low test speed, but no signs of weakness of the external rotators, in the dominant arm of the volleyball players.
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| 34. |
- Alfredson, Håkan
(författare)
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Eccentric calf muscle training : the story
- 2010
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Ingår i: Sportverletzung, Sportschaden. - : Georg Thieme Verlag KG. - 0932-0555 .- 1439-1236. ; 24:4, s. 188-189
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Tidskriftsartikel (refereegranskat)
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| 35. |
- Alfredson, Håkan, et al.
(författare)
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Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment?
- 2001
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 9:2, s. 123-126
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Tidskriftsartikel (refereegranskat)abstract
- In this investigation, we show the presence of both free glutamate (microdialysis) and glutamate NMDAR1 receptors (immunohistochemical analyses of tendon biopsies), in tendons from patients with chronic Achilles tendon pain (Achilles tendinosis) and in controls (pain-free tendons). The NMDAR1 immunoreaction was usually confined to acetylcholinesterase-positive structures, implying that the reaction is present in nerves. Glutamate is a potent pain mediator in the human central nervous system, and in animals it has been shown that peripherally administered glutamate NMDA receptor antagonists diminish the response to formalin-induced nociception. Our present finding of glutamate NMDA receptors in human Achilles tendons might have implications for pain treatment.
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| 36. |
- Alfredson, Håkan, et al.
(författare)
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Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis
- 1998
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Ingår i: American Journal of Sports Medicine. - : Sage. - 0363-5465 .- 1552-3365. ; 26:3, s. 360-366
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Tidskriftsartikel (refereegranskat)abstract
- We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
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| 37. |
- Alfredson, Håkan, et al.
(författare)
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High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique.
- 2002
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Ingår i: Journal of Orthopaedic Research. - 0736-0266 .- 1554-527X. ; 20:5, s. 934-938
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Tidskriftsartikel (refereegranskat)abstract
- In this investigation the microdialysis technique was used to study the concentrations of lactate in Achilles tendons with painful chronic tendinosis and in normal pain-free tendons. In four patients (mean age 40.7 years) with a painful thickening localized at the 2-6 cm level in the Achilles tendon (chronic Achilles tendinosis) and in five controls (mean age 37.2 years) with normal Achilles tendons the local concentrations of lactate were registered under resting conditions. All tendons were examined using ultrasonography. In the tendons with tendinosis the painful thickening corresponded to a widened tendon and structural tendinosis changes. Normal tendons showed no widening and a normal structure. A standard microdialysis catheter was inserted into the Achilles tendon under local anesthesia. Samplings were done every 15 min during a 4 h period. The results showed significantly higher mean concentrations of lactate in tendons with tendinosis compared to normal tendons (2.15 mmol/l vs. 1.14 mmol/l). The lactate concentrations in the tendons with tendinosis were stable, and approximately twofold higher than in the normal tendons during the whole 4 h investigation period. In conclusion, the higher concentrations of lactate in Achilles tendons with painful tendinosis indicate that there are anaerobic conditions in the area with tendinosis. The importance of this finding for the pathogenesis and pain mechanisms in this chronic condition needs to be further investigated.
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| 38. |
- Alfredson, Håkan, et al.
(författare)
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High thigh muscle strength but not bone mass in young horseback-riding females
- 1998
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Ingår i: Calcified Tissue International. - : Springer. - 0171-967X .- 1432-0827. ; 62:6, s. 497-501
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate whether the type of weight-bearing loading subjected to the skeleton during horseback-riding was associated with differences in bone mass and muscle strength of the thigh, we investigated bone mass and isokinetic muscle strength in 20 female horse riders (age 17.9 +/- 0.6 years) who were riding 7.0 +/- 3.4 hours/week, and 20 nonactive females (age 17.8 +/- 1.1 years). The groups were matched according to age, weight, and height. Areal bone mineral density was measured in total body, head, lumbar spine, right femoral neck, Ward's triangle, and trochanter, the whole dominant and nondominant humerus, and in specific sites in the right femur diaphysis, distal femur, proximal tibia, and tibia diaphysis using dual X-ray absorptiometry. Isokinetic concentric and eccentric peak torque of the quadricep and hamstring muscles were measured using an isokinetic dynamometer. There were no significant differences in bone mass between the horseback riders and nonactives at any site measured. The horse riders were significantly (P < 0.05-0.01) stronger in concentric hamstrings strength at 90 degrees/second and 225 degrees/second and in eccentric quadricep and hamstring strength at 90 degrees/second. Horseback riding in young females is associated with a high muscle strength of the thigh, but not with a high bone mass.
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| 39. |
- Alfredson, Håkan, et al.
(författare)
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In situ microdialysis in tendon tissue : high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain
- 1999
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 7:6, s. 378-381
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Tidskriftsartikel (refereegranskat)abstract
- This investigation was to our knowledge the first to use the microdialysis technique to study concentrations of substances in a human tendon. In four patients (mean age 40.7 years) with a painful nodule in the Achilles tendon (chronic Achilles tendinosis) and in five controls (mean age 37.2 years) with normal Achilles tendons (confirmed by ultrasonography) the local concentrations of glutamate and prostaglandin E2 were measured under resting conditions. A standard microdialysis catheter was inserted into the Achilles tendon under local anesthesia. Sampling was performed every 15 min over a 4-h period. The results showed significantly higher concentrations of glutamate in tendons with tendinosis than in normal tendons (196 +/- 59 vs. 48 +/- 27 mumol/l, P < 0.05), and there were no significant changes in glutamate concentration over the period of investigation. There were no significant differences in the mean concentrations of prostaglandin E2 (83 +/- 22 vs. 54 +/- 24 pg/ml) between tendons with tendinosis and normal tendons. In conclusion, in situ microdialysis appears a useful method to study certain metabolic events in tendon tissue. The higher concentrations of the excitatory neurotransmitter glutamate in Achilles tendons with a painful nodule may possibly be involved in the pain mechanism in this chronic condition. Furthermore, there were no signs of inflammation in the tendons with painful nodules, as indicated by the normal prostaglandin E2 levels.
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| 40. |
- Alfredson, Håkan, et al.
(författare)
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In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper's knee.
- 2001
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Ingår i: Journal of Orthopaedic Research. - 0736-0266 .- 1554-527X. ; 19:5, s. 881-886
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Tidskriftsartikel (refereegranskat)abstract
- This investigation describes, to our knowledge, the first experiment where the microdialysis technique was used to study certain metabolic events in human patellar tendons in combination with immunohistochemical analyses of tendon biopsies. In five patients (four men and one woman) with a long duration (range 12-36 months) of pain symptoms from Jumper's knee (localized tenderness in the patellar tendon verified as tendon changes with ultrasonography or MRI), and in five controls (four men and one woman) with normal patellar tendons, a standard microdialysis catheter was inserted into the patellar tendon under local anestesia. The local concentrations of glutamate (excitatory neurotransmitter) and prostaglandin E2 (PGE2) were registered under resting conditions. Samplings were done every 15 min during a 2 h period. In all individuals (patients and controls) biopsies were taken for immunohistochemical analyses. The results showed that it was possible to detect and measure the concentrations of glutamate and PGE2 in the patellar tendon with the use of microdialysis technique. There were significantly higher concentrations of free glutamate, but not PGE2, in tendons with tendinosis compared to normal tendons. In the biopsies, there were no inflammatory cell infiltrates, but, for the first time, it was shown that there was immunoreaction for the glutamate receptor NMDAR1 in association with nerve structures in human patellar tendons. These findings altogether indicate that glutamate might be involved in painful Jumper's knee, and further emphasizes that there is no chemical inflammation (normal PGE2 levels) in this chronic condition.
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