Article Text

Dutch multidisciplinary guideline on Achilles tendinopathy
  1. Robert-Jan de Vos1,
  2. Arco C van der Vlist1,
  3. Johannes Zwerver2,3,
  4. Duncan Edward Meuffels1,
  5. Frank Smithuis4,
  6. Ronald van Ingen5,
  7. Florus van der Giesen6,
  8. Edwin Visser7,
  9. Astrid Balemans8,
  10. Margreet Pols8,
  11. Natasja Veen8,
  12. Mirre den Ouden8,
  13. Adam Weir1,9,10
  1. 1 Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  2. 2 Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands
  3. 3 Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
  4. 4 Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
  5. 5 General Practice Van Ingen -Breugem, Apeldoorn, The Netherlands
  6. 6 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  7. 7 Sportgeneeskunde Rotterdam, Rotterdam, The Netherlands
  8. 8 Knowledge Institute of the Federation of Medical Specialists, Utrecht, The Netherlands
  9. 9 Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Doha, Qatar
  10. 10 Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
  1. Correspondence to Dr Robert-Jan de Vos, Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands; r.devos{at}


Objective To provide a comprehensive, evidence-based overview of the risk factors, prevention, diagnosis, imaging, treatment and prognosis for Achilles tendinopathy. To make clinical recommendations for healthcare practitioners and patients.

Design Comprehensive multidisciplinary guideline process funded by the Quality Foundation of the Dutch Federation of Medical Specialists. This process included a development, commentary and authorisation phase. Patients participated in every phase.

Data sources Multiple databases and existing guidelines were searched up to May 2019. Information from patients, healthcare providers and other stakeholders were obtained using a digital questionnaire, focus group interview and invitational conference.

Study eligibility criteria Studies on both insertional and/or midportion Achilles tendinopathy were eligible. Specific eligibility criteria were described per module.

Data extraction and synthesis To appraise the certainty of evidence, reviewers extracted data, assessed risk of bias and used the Grading of Recommendations Assessment, Development and Evaluation method, where applicable. Important considerations were: patient values and preferences, costs, acceptability of other stakeholders and feasibility of implementation. Recommendations were made based on the results of the evidence from the literature and the considerations.

Primary outcome measure The primary and secondary outcome measures were defined per module and defined based on the input of patients obtained in collaboration with the Netherlands Patient Federation and healthcare providers from different professions.

Results Six specific modules were completed: risk factors and primary prevention, diagnosis, imaging, treatment prognosis and secondary prevention for Achilles tendinopathy.

Summary/conclusion Our Dutch multidisciplinary guideline on Achilles tendinopathy provides six modules developed according to the standards of the Dutch Federation of Medical Specialists. Evidence-based recommendations for clinical practice are given for risk factors, prevention, diagnosis, imaging, treatment and prognosis. This guideline can assist healthcare providers and patients in clinical practice.

  • achilles tendon
  • risk factor
  • injury prevention
  • ultrasonography
  • treatment

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Supplementary materials


  • Twitter @rj_devos, @ArcoVlist, @HansZwerver, @ronaldvaningen, @astrid_balemans, @AdamWeirSports

  • Correction notice This article has been corrected since it published Online First. The supplementary files have been updated.

  • Contributors R-JdV initiated the project. R-JdV, ACvdV and MdO were involved in designing the project. ACvdV and R-JdV coordinated the project. ACvdV, AB, MP and NV provided support for the project by searching the literature, screening trials for inclusion, interpretation of the results of the data analyses and they checked whether the process followed the standards of the Dutch Federation of Medical Specialists. All members from the workgroup (R-JdV, JZ, DEM, FS, RvI, FvdG and EV) were responsible for screening trials, the risk of bias assessment, data extraction, interpretation of the results of the data-analyses and the formulation of the final recommendations. All workgroup members were responsible for one specific Module of Submodule of the guideline and drafted the first version of this Module of Submodule with assistance of R-JdV and ACvdV. AW drafted the translated version of the Dutch guideline into English. R-JdV is project guarantor. All authors reviewed the final guideline and agreed to be accountable for all aspects of the work and approved the final manuscript for submission. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This project received a grant from the Dutch Association of Medical Specialists to develop a clinical guideline for the management of patients with Achilles tendinopathy. The Netherlands Patient Federation is involved in this guideline development and assisted in sending out patient surveys. This non-commercial association is not involved in the planning, conduct or reporting of this project.

  • Competing interests The personal financial interests, personal relationships, external research funding, intellectual property and other potential conflicts of all authors are described in the supplementary file.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.