Injectie therapieën Chronische midportion Achilles tendinopathie

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1 Injectie therapieën Chronische midportion Achilles tendinopathie
R.J. de Vos MD, PhD Sportarts en post-doc onderzoeker Erasmus MC Rotterdam 30 oktober 2015 Nerass congres, Woerden

2 Proefschrift 2010

3 SBV Excelsior Rotterdam
Erasmus MC Rotterdam

4 Tendons are ‘hot’…..1 1 Wilson and Goodship. 1994
The temperature in Superfiscial digital flexor tendons of horses can rise up to 45 degrees. Kinetic energy is stored transiently as strain energy in the tendon. Elastic recoil then converts most of the stored energy back to kinetic energy as the foot leaves the ground. This important mechanism saves substantial quantities of muscular energy during locomotion (Alexander, 1988). The stored strain energy, however, is not all recoverable, owing to internal viscous damping, and some 5–10 % is released as heat (Ker 1 Wilson and Goodship. 1994

5 Anatomie Achillespees
Spieren Gastrocnemius Soleus Energy storage-release 1 1 O’Brien. 2005

6 Focus Midportion 2-7 cm proximaal van insertie Geïsoleerde pathologie

7 Diagnose Tendinopathie = klinische diagnose 1 Pijn Zwelling
Verminderde belastbaarheid 1 Maffulli et al. 1998

8 Belangrijk probleem? Incidentie Achillespeesklachten Nederlandse huisartsenpraktijk: 2.35/1000 volwassenen 1 ‘Life-time risk’ competitieve hardlopers > 50% 2 1 de Jonge et al. 2011 2 Jarvinen et al. 2005

9 Belangrijk probleem? 1e lijns behandeling (EOT) effectief in 25% 1
Na 5 jaar follow-up slechts 40% pijnvrij 2 Implicaties voor betere behandeling Gericht op pathologie 1 Ram et al. 2013 2 Van der Plas et al. 2011

10 Echografie – hypoechogene gebieden 1,2
1 Khan et al. 2003 2 Archambault et al. 1998