Inflammation of paratenon that may also involve Kager fat pad
Tendinopathy: acute and chronic tendon pathology excluding rupture
Tendon degeneration and minor inflammation coexist in abnormally thickened tendon
Insertional: 25% associated with Haglund deformity
Noninsertional: occurs at watershed area, 2-6 cm proximal to insertion
Achilles watershed area: area of relative hypovascularity in mid tendon, 2-6 cm proximal to insertion
IMAGING
General Features
Radiographic Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
Relevant Anatomy
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Maffulli N et al: Achilles tendinopathy. Foot Ankle Surg. 26(3):240-9, 2020
Steinmann S et al: Spectrum of tendon pathologies: triggers, trails and end-state. Int J Mol Sci. 21(3), 2020
Barg A et al: Surgical strategies for the treatment of insertional achilles tendinopathy. Foot Ankle Clin. 24(3):533-59, 2019
Bäcker HC et al: MRI assessment of degeneration of the tendon in achilles tendon ruptures. Foot Ankle Int. 40(8):895-9, 2019
Jennings MM et al: Updates in tendinopathy treatment options. Clin Podiatr Med Surg. 36(4):543-52, 2019
Müller SA et al: The role of the paratenon in Achilles tendon healing: a study in rats. Am J Sports Med. 46(5):1214-9, 2018
Lawrence JE et al: Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 99-B(1):87-93, 2017
Ahmad J et al: Treatment of myotendinous Achilles ruptures. Foot Ankle Int. 34(8):1074-8, 2013
Fernández-Sarmiento JA et al: Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am. 95(3):246-55, 2013
Thevendran G et al: The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 97(1):9-20, 2013
Soroceanu A et al: Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94(23):2136-43, 2012
Calleja M et al: The Achilles tendon. Semin Musculoskelet Radiol. 14(3):307-22, 2010
Willits K et al: Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 92(17):2767-75, 2010
Courville XF et al: Current concepts review: noninsertional Achilles tendinopathy. Foot Ankle Int. 30(11):1132-42, 2009
Luck MD et al: High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 37(12):1129-33, 2008
Richards PJ et al: Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil. 30(20-22):1651-65, 2008
Sode J et al: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 63(5):499-503, 2007
Chiodo CP et al: Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 27(4):305-13, 2006
Dobson MH et al: Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 88(5):1160; author reply 1160, 2006
Hartgerink P et al: Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 220(2):406-12, 2001
Schweitzer ME et al: MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 175(3):613-25, 2000
Inflammation of paratenon that may also involve Kager fat pad
Tendinopathy: acute and chronic tendon pathology excluding rupture
Tendon degeneration and minor inflammation coexist in abnormally thickened tendon
Insertional: 25% associated with Haglund deformity
Noninsertional: occurs at watershed area, 2-6 cm proximal to insertion
Achilles watershed area: area of relative hypovascularity in mid tendon, 2-6 cm proximal to insertion
IMAGING
General Features
Radiographic Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
Relevant Anatomy
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Maffulli N et al: Achilles tendinopathy. Foot Ankle Surg. 26(3):240-9, 2020
Steinmann S et al: Spectrum of tendon pathologies: triggers, trails and end-state. Int J Mol Sci. 21(3), 2020
Barg A et al: Surgical strategies for the treatment of insertional achilles tendinopathy. Foot Ankle Clin. 24(3):533-59, 2019
Bäcker HC et al: MRI assessment of degeneration of the tendon in achilles tendon ruptures. Foot Ankle Int. 40(8):895-9, 2019
Jennings MM et al: Updates in tendinopathy treatment options. Clin Podiatr Med Surg. 36(4):543-52, 2019
Müller SA et al: The role of the paratenon in Achilles tendon healing: a study in rats. Am J Sports Med. 46(5):1214-9, 2018
Lawrence JE et al: Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 99-B(1):87-93, 2017
Ahmad J et al: Treatment of myotendinous Achilles ruptures. Foot Ankle Int. 34(8):1074-8, 2013
Fernández-Sarmiento JA et al: Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am. 95(3):246-55, 2013
Thevendran G et al: The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 97(1):9-20, 2013
Soroceanu A et al: Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94(23):2136-43, 2012
Calleja M et al: The Achilles tendon. Semin Musculoskelet Radiol. 14(3):307-22, 2010
Willits K et al: Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 92(17):2767-75, 2010
Courville XF et al: Current concepts review: noninsertional Achilles tendinopathy. Foot Ankle Int. 30(11):1132-42, 2009
Luck MD et al: High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 37(12):1129-33, 2008
Richards PJ et al: Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil. 30(20-22):1651-65, 2008
Sode J et al: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 63(5):499-503, 2007
Chiodo CP et al: Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 27(4):305-13, 2006
Dobson MH et al: Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 88(5):1160; author reply 1160, 2006
Hartgerink P et al: Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 220(2):406-12, 2001
Schweitzer ME et al: MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 175(3):613-25, 2000
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