A Brief Case Report on Umbilical Cord Connective Tissue Allograft Application for Achilles Tendonitis

Enthesopathies of the lower extremities are extremely common in adult populations regardless of athletic background. Achilles tendonitis, one of the most common, primarily affects patients over fifty. Enthesopathy can be caused by a loss of fibrillar structure secondary to edema, or mineralization, which leads to calcification and ossification, diffuse inflammatory disease, or altered structure of collagen fibers leading to a thickened enthesis1. The patient in this study is a 54-year-old female who presented with chronic Achilles tendonitis with retro calcaneus exostosis and pain for over three years despite conservative care before referral for regenerative interventions. She works an active job requiring her to be on her feet approximately 75% of the time, further aggravating the disorder and causing sharp burning pain.  

Standard care practices for Achilles tendonitis vary from over-the-counter anti-inflammatories or corticosteroid injections with functional rehabilitation therapy to surgical intervention in severe cases. Best practices are still widely debated as the Achilles tendon's pain mechanisms are poorly understood2. It is common for surgeons to experience patients with significant retrocalcaneal exostosis and no pain as frequently as the reverse circumstance. The subject in this study presented with a retrocalcaneal exostosis of the right leg, severe pain, and declining surgical intervention (figure 1). Previously, the patient underwent two procedures, one successful inferior calcaneal osteotomy and one minimally successful retro calcaneal osteotomy on the contra-lateral foot (figure 2). Recent literature has demonstrated promising alternative interventions, including sound wave therapy, laser therapy, and regenerative tissue allograft supplementation3,4. This retrospective case study aims to present novel application techniques and preliminary evidence of the efficacy and safety of these interventions on a patient who has failed standard-of-care practices for over two years.

The procedure included the application of an umbilical cord tissue matrix, also known as Wharton’s Jelly, extra-corporeal pulsed-activated therapy (EPAT), and class IV laser therapy. At the initial visit, 2cc of CryoText, a minimally manipulated umbilical cord tissue allograft, was thawed as per laboratory guidelines and transplanted along the at the insertion to the calcaneus of the right foot using MyLab 15.0 M Hz real-time diagnostic ultrasound guidance with a 4cm transducer head. The patient was prepped with standard sterile technique. The allograft was strategically placed throughout the inflamed tissues. Before the application, the patient received EPAT at 11Hrtz, 1.4 bars, for 3521 pulses. The patient was then scheduled twice weekly for class IV laser treatments for the next three weeks to provide photobiomodulation which has been shown to lower inflammatory markers, as well as a pre-fabricated pneumatic boot4.