Page 139 - 《运动与健康科学》(英文)2024年第2期

TaggedAPTARAEndEpidemiology of Achilles tendinopathy 261
TaggedAPTARAPThe incidence rate of AT in the general population was risk was found after a short recovery time (less than 10 days) as
reported as 1.85 per 1000 registered patients in Dutch general opposed to a longer recovery. While these data suggest that more
practice networks 22 and1.7 per1000registeredpatientsina time for recovery is an effective prevention for recurrent AT,
33
Danish general practice. 23 In runners, the incidence reported in there are still many questions regarding this specific subgroup. TaggedAPTARAEnd
2
the literatures varied from 5.2% to 10.9%. 17,24,25 In the current TaggedAPTARAPSubclassification of AT is common practice. AT has been
study, the incidence among all participants and those who regis- divided into insertional and midportion (non-insertional) subtypes
tered for a marathon were 4.2% and 5.0%, respectively, both since Clain and Baxter’s 1992 study. 34 These subtypes have
lowerthaninacomparable studypopulation(5.2% and7.4%). 17 varied etiology, histopathological features, 35 and macroscopic
36
Coronavirus disease 2019 pandemic restrictions could at least findings during surgery. Midportion AT is localized more than
partially explain the differences in incidence. A previous study 2 cm above the tendon insertion and occurs in or around the
reported that the peak incidence of AT emerged in the period tendon substance. 34 Previous studies speculated that localized
between 2 weeks before and 1 day after the event, 17 while the torque stresses from the tendon or pathologic alterations in the
peak of onset in the current study emerged during the period paratenon might lead to midportion AT. 37 Degeneration of the
between 44 and 15 days prior to the event. The current peak of tendon substance 38 or acute/chronic inflammation in the para-
onset might be related to the cancellation of the Nationale-Neder- tenon could be found in histopathological studies. 39 Insertional
landen marathon Rotterdam event (50% of participants in this AT is localized within 2 cm of the tendon insertion and involves
study), which was due to the coronavirus disease 2019 pandemic the tendonbone interface. Researchers contend that insertional
and was announced 24 days before the originally scheduled event AT is the result of the Achilles tendon being abraded by the bony
26
date. The suspension of the event probably disturbed the training prominence at the posterior superior tuberosity of calcaneus. In
schedule of the participants, thereby preventing the high peak of addition, the insertional part of the Achilles tendon could also be
injuries that may have emerged later. Both studies demonstrated a chemically eroded when there is chronic inflammation of retro-
relatively high risk for developing a new-onset AT in the final calcaneal bursa. 34 Histopathological features of insertional AT
training stage before a marathon, suggesting this is a crucial time include ossification of enthesial fibrocartilage and degeneration
of soft tissue at the tendonbone junction. 40 Retrocalcaneal
frame for AT prevention in recreational marathon runners.TaggedAPTARAEnd
TaggedAPTARAPAT has always been regarded as an “overuse injury”. 27 We bursitis and Haglund morphology are pathologies that can be
found that participants registered for a marathon had a higher present in conjunction with insertional AT. 36 According to the
2
incidence of AT than any other race distance, and participants current internationally published guidelines, these subtypes are
who registered for a 10-km race had significantly lower chances treated with different exercise programs, as the insertional region
of having new-onset AT or midportion AT. However, there is is regarded to be more subjected to compressive forces than the
41
currently no convincing evidence for change in absolute training other region. There are limited data available on the proportion
2
load as a risk factor for AT. Hence, the attention shifted to the of AT subtypes in the general population, and the origin of these
9
sudden change in training volume. Hulin et al. 28 developed a figures can be traced back to 2 cross-sectional studies of injured
parameter to measure to the relative change of workload: acute: athletes from the 1990s. 42,43 However, due to the inconsistent use
chronic workload ratios (ACWR), which was defined as the ratio of terminology throughout the years, researchers have subclassi-
of the latest 1-week workload to the average workload of the fied Achilles tendon injuries in different ways. Kvist et al. 43
previous 4 weeks. The significant association between high examined 455 athletes with Achilles tendon overuse injuries in a
ACWR and overall injury occurrence was shown recently in sports medicine clinic and found that 23% had insertional pain,
various sports. 2831 Nakaoka et al. 32 were the first to report on 66% had midportion AT (referred to as paratenonitis), and 8%
42
the ACWR and injury risk in runners, and they found a significant had complaints of the myotendineal junction. Leppilahti et al.
association between higher ACWR and lower injury risk among diagnosed 330 cases of Achilles tendon injuries (including
recreational runners. Nevertheless, no studies have used this tool tenalgia, tendinosis, peritendinitis, partial rupture, and retrocalca-
to focus on the onset of AT. With the concept of ACWR in mind, neal bursitis) in 273 athletes. Thirty-three (10%) of the injuries
this study uses the month:year distance ratio and the month:year were insertional problems and 56 (17%) were retrocalcaneal
speed ratio to detect recent adjustments in training volume and bursitis. It should be noted that both studies focused on a specific
running performance from long-existing patterns. To our knowl- population attending a secondary clinic, which may induce selec-
edge, this is the first prospective cohort study investigating the tion bias. Based on the terminology and subclassifications in the
2
association between the change of training load and the risk of latest guidelines, our data showed that 28% of the new-onset AT
AT, though no significant association was found. Future studies was insertional and 64% was midportion. It is likely that this is a
should use more advanced serial measures of training load to better representation of the proportion of AT subtypes in the
athletic population than the previous studies and could provide a
identify whether overuse is a risk factor for AT.TaggedAPTARAEnd
TaggedAPTARAPHaving a history of AT in the past 12 months before baseline more up-to-date reference for clinical practice nowadays.TaggedAPTARAEnd
is the predominant risk factor for new-onset AT, which is a TaggedAPTARAPThis is the first prospective study to explore risk factors for
finding that agrees with previous literatures. 14,17,24 In the current specific subtypes of AT. We found that younger age was a risk
study, 31% of the new-onset AT were recurrent injuries, factor for insertional AT only. Previous reviews often regarded
suggesting the importance of preventing recurrence. Gajhede- advancing age as a risk factor for Achilles disorders, 44,45 though
Knudsen et al. 33 reported a 27% recurrence rate of AT among these conclusions were drawn from cross-sectional studies that
professional football players. A significantly higher recurrence did not separate insertional AT from the whole group. 42,43 On the