The Case of Insertional Adductor Tendinopathy of an International-Level 3,000-m Steeplechase Runner

Background: Groin pain is a frequent condition among athletes. One of the causes of groin pain is tendinopathy, a frequently diagnosed medical condition, which can also occur in the adductor muscles. Despite the high prevalence of this medical condition among athletes, it is infrequent to observe tendinopathic groin pain in steeplechase runners. The aim of this case study is to describe the case of an international-level 3,000-m steeplechase runner with groin pain, who was subsequently diagnosed with adductor insertional tendinopathy.Case Presentation: We present the case of an Italian 3,000-m steeplechase and long distance runner, Ala Zoghlami (180 cm, 57 kg), with groin pain, diagnosed as insertional adductor tendinopathy. The runner, after manifesting the painful symptomatology, underwent medical screening (ultrasound and MRI). The radiological investigations highlighted adductor tendinopathy. After refraining from training, the runner underwent medical and physical therapy which, in the first phase, did not improve the painful symptomatology. Further evaluation, after 6 months from the initial training cessation, highlighted a case of malocclusion. Such was treated from a dentistry perspective with the creation of a personalized dental bite.Results: A multidisciplinary approach which included medical and physical therapy, osteopathy, and dentistry, in adjunct with refraining from training, was able to reduce the symptomatology and allowed a correct return to run (after 9 months from the first painful manifestation) of the steeplechase runner. To date, Ala Zoghlami has fully recovered and was able to win the 3,000-m steeplechase race during the 2021 national Italian competition.

Do pre-operative radiologic assessment predict postoperative outcomes in patients with insertional Achilles tendinopathy?: a retrospective database study

Introduction Diagnosis and treatment of insertional tendinopathy of the Achilles tendon (IAT) remains a challenge. The aim of this study was to assess the influence of pre-operative radiological pathologies on the patient-reported outcomes following open debridement of all pathologies for IAT. Materials and methods In this IRB-approved retrospective correlation and comparative study, patients with pre-operative imaging were identified from the authors’ retrospective IAT database comprising of 118 patients. All were treated by a standardized surgical treatment strategy utilizing a midline, transachillary approach and debridement of all pathologies. A total of fifteen radiologic parameters were measured on radiographs (RX) and MRI. The patient-reported outcomes were assessed using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-G) and the general health questionnaire SF-12 at a minimum follow-up of 12 months. The data are presented as mean ± SD (95% CI). Results 88 patients (74.6%) with an average age of 50 ± 12 (47–52) years were included. Radiographs were available in 68 patients and MRI in 53. The mean follow-up was 3.8 ± 1.9 (3.4–4.3) years. The overall VISA-A-G was 81 ± 22 (77–86), the SF-12 PCS 54 ± 7 (52–55), and the SF-12 MCS 52 ± 9 (50–54) points. None of the assessed radiological parameters had a significant influence on the patient-reported outcome following surgical treatment for IAT. Conclusion In this retrospective correlation study, no significant association was found between preoperative radiographic and MRI radiologic parameters for IAT and postoperative patient-reported outcomes (VISA-A-G and SF-12).

Comparative Evaluation of the Presence of Insertion Enthesophyte in the Achilles Tendon by X-Ray and Magnetic Resonance Imaging: Intra and Inter Observer Reliability

Category: Other; Sports Introduction/Purpose: To evaluate the intra and interobserver variation on the presence of enthesophyte in patients with Achilles insertional tendinopathy and the clinical radiological correlation of x-ray (X-ray) and magnetic resonance images (MRI). Methods: We selected Lateral X-ray images of the calcaneus and videos of ankle MRI in which we showed the entire thickness of the calcaneus in the coronal, sagittal and axial views, in both T1 and T2 weightings, of 20 patients with Achilles insertional tendinopathy. 5 foot and ankle surgeons and 5 musculoskeletal radiologists, with varied experience time, analysed the images. Intra and Interobserver correlations were studied with the kappa index. Results: The average Ƙ intraobserver of the results of the MRI analyzes was 0.49, and the average Ƙ interobserver of the results of the MRI analyzes was 0.47. The mean Ƙ intraobserver values of the results of the X-ray analyzes were 0.61, while the Ƙ interobserver had a value of 0.60. We also observed that the group of less experienced surgeons and radiologists showed a worse Ƙ intraobserver than the more experienced ones. Conclusion: The values are in agreement with previous studies, confirming moderate intraobserver and interobserver reproducibility in MRI exams and good or substantial interobserver and interobserver reliability in X-ray exams.

PO 18076 - Shockwave therapy associated with eccentric strengthening for Achilles insertional tendinopathy

Introduction: Conservative treatment for insertional Achilles tendinopathy (IAT) has failed to produce encouraging results in recent years. Shockwave therapy (SWT) has become a reliable option for the management of this disease in recent years. The objective of this study is to report the effectiveness of low-energy SWT combined with an eccentric strengthening protocol in 19 consecutive patients. Methods: This is a prospective study of 19 patients diagnosed with IAT. The protocol consisted of SWT combined with eccentric training for 12 weeks. All patients were evaluated on the first day and after 24 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) score, the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and algometry. The patients were also evaluated for compliance with the protocol, complications and final outcome. Results: All patients completed the study without complications. In total, 15 (79%) patients fully complied with the Alfredson protocol, and 13 (68%) considered the treatment successful. At the final evaluation, the patients required more pressure on the calcaneus to trigger pain (Algometry 1), reported less pain when applying the algometer with 3 kg of pressure (Algometry 2) and had less global pain (VAS) and higher AOFAS and VISA-A scores. All differences were significant. Conclusion: Eccentric training combined with SWT is an effective treatment for IAT. Further placebo-controlled studies with a longer follow-up are necessary to support this statement.

Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy

Category: Sports Introduction/Purpose: Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy. Methods: We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests. Results: The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT. Conclusion: The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.