Achilles tendinopathy in sport: Anatomical site, completed loading and return to performance

Abstract

Persistent Achilles tendon pain requires assessment of anatomical location, completed exercise and the sporting activity that remains restricted. This study examines adult nonoperative care. Treatment comparisons are interpreted by eligibility criteria, dose, adherence, comparator and follow-up; no meta-analysis or formal certainty grading was undertaken. A 58-patient trial found improvement with both eccentric exercise and heavy slow resistance, with adherence of 78% and 92%, respectively. In 40 recreational athletes, Alfredson and Silbernagel programmes produced an adjusted VISA-A difference of 2.4 points (95% CI −8.5 to 13.3). Insertional disease requires separate interpretation: a 119-patient trial found no added 24-week benefit from radial shockwave treatment during eccentric exercise. Injection comparisons also differed. Six-month or 24-week VISA-A contrasts were −2.7 points (95% CI −8.8 to 3.3) for platelet-rich plasma, 0.5 (−17.8 to 18.8) for high-volume saline/lidocaine, and 17.7 (8.4 to 27.0) for corticosteroid plus exercise. The corticosteroid comparison included three months without running or jumping and measured differences in improvement rather than endpoint scores. VISA-A change, unrestricted sport and restoration of previous performance are distinct outcomes. Treatment escalation should follow assessment of the exercise completed, anatomical diagnosis and residual sporting limitation, with each intervention interpreted under the conditions tested.