A Case Report on Umbilical Cord Connective Tissue Allograft Application in Combination with Other Modalities for Defects of the Achilles Tendon.

Damaged connective tissues between the bone and tendons or ligaments are common among adults regardless of activity level. Achilles tendinosis is one of the most common tissue defects and enthesopathies. This case report presents the novel application of Wharton's jelly to supplement tissue defects in the Achilles tendon and its insertion. The patient in this study is a 54-year-old female with slow-onset chronic Achilles tendinosis from chronic enthesopathy at the Achilles tendon insertion with a retrocalcaneal exostosis progressively worsening for 3 years, who failed standard-of-care practices for more than 3 years. Her previous care included rest, one successful inferior calcaneal osteotomy, and one minimally successful retrocalcaneal resection of the contralateral foot, both performed by prior surgeons. The patient received extracorporeal pulsed-activated therapy (EPAT) before applying 2 mL of CryoText, a Wharton's jelly tissue allograft. The patient then received class IV laser therapy treatments. The patient started with a 10/10 visual analog scale (VAS) at the initial visit, and by week 13, the patient rated her pain as 0/10 VAS. The improvement in patient-reported pain and functionality reported in this study after the application of Wharton's Jelly, EPAT, and class IV laser therapy warrants future research studying the safety and efficacy of these patient care modalities together as an alternative intervention for patients with Achilles Tendinosis who have failed other standard-of-care treatments. Future research will help identify additional application sites and solidify application and dosage protocols.