PT  - JOURNAL ARTICLE
AU  - van der Plas, A
AU  - de Jonge, S
AU  - de Vos, R J
AU  - van der Heide, H J L
AU  - Verhaar, J A N
AU  - Weir, A
AU  - Tol, J L
TI  - A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy
AID  - 10.1136/bjsports-2011-090035
DP  - 2012 Mar 01
TA  - British Journal of Sports Medicine
PG  - 214--218
VI  - 46
IP  - 3
4099  - http://bjsm.bmj.com/content/46/3/214.short
4100  - http://bjsm.bmj.com/content/46/3/214.full
SO  - Br J Sports Med2012 Mar 01; 46
AB  - Background Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design Part of a 5-year follow-up of a previously conducted randomised controlled trial. Methods 58 patients (70 tendons) were approached 5 years after the start of the heel-drop exercise programme according to Alfredson. At baseline and at 5-year follow-up, the validated Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire score, pain status, alternative treatments received and ultrasonographic neovascularisation score were recorded. Results In 46 patients (58 tendons), the VISA-A score significantly increased from 49.2 at baseline to 83.6 after 5 years (p<0.001) and from the 1-year to 5-year follow-up from 75.0 to 83.4 (p<0.01). 39.7% of the patients were completely pain-free at follow-up and 48.3% had received one or more alternative treatments. The sagittal tendon thickness decreased from 8.05 mm (SD 2.1) at baseline to 7.50 mm (SD 1.6) at the 5-year follow-up (p=0.051). Conclusion At 5-year follow-up, a significant increase of VISA-A score can be expected. After the 3-month Alfredson's heel-drop exercise programme, almost half of the patients had received other therapies. Although improvement of symptoms can be expected at long term, mild pain may remain.