Achilles tendinopathy in the main body (mid-portion) of the tendon is a common pathologic finding among active and athletic populations and can be debilitating without proper and adequate treatment. Numerous surgical approaches for this common pathologic finding have been reported, with variable outcomes. We evaluated the surgical outcomes of peritenolysis and debridement of main body Achilles tendinopathy among athletic populations using the return to activity (RTA) and decreased desired activity (DDA) as our primary outcome measures. A total of 100 patients underwent 107 procedures by the senior author (A.S.) from January 2001 through December 2015 met the inclusion criteria, 65 (65%) of whom were runners. The mean follow-up duration was 106.6 ± 55.5 months from the index procedure, and the mean interval necessary to RTA for the entire group was 10.9 ± 5.3 weeks. The average RTA after debridement was 14.1 ± 5.2 weeks and after peritenolysis was 7.3 ± 2.0 weeks (p = .00001). Of the 100 patients, 3 (3%) had experienced a DDA at the last follow-up visit. With >97% of the patients able to return to their desired activities, we have concluded that peritenolysis and debridement are favorable surgical techniques for main body Achilles tendinopathy.
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Acute and overuse injuries correlated to hours of training in master running athletes.Foot Ankle Int. 2008; 29: 671-676
- Incidence of midportion Achilles tendinopathy in the general population.Br J Sports Med. 2011; 45: 1026-1028
- Terminology for Achilles tendon related disorders.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 835-841
- Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles tendinopathy: a prospective study.J Foot Ankle Surg. 2011; 50: 315-319
- High volume image guided injections in chronic Achilles tendinopathy.Disabil Rehabil. 2008; 30: 1697-1708
- Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.Am J Sports Med. 1998; 26: 360-366
- Treatment of midportion Achilles tendinosis: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing polidocanol injections.Knee Surg Sports Traumatol Arthr. 2007; 15: 1504-1509
- Surgery for chronic Achilles tendinopathy: review of 91 procedures over 10 years.J Am Podiatr Med Assoc. 2003; 93: 283-291
- Long-term prognosis of patients with Achilles tendinopathy: an observational 8-year follow-up study.Am J Sports Med. 2000; 28: 634-642
- Surgical treatment for midportion Achilles tendinopathy: a systematic review.Knee Surg Sports Traumatol Arthrosc. 2017; 17: 207
- Surgical treatment for Achilles tendinopathy—a systematic review.BMC Musculoskelet Disord. 2016; 17: 207
- Magnetic resonance and cadaveric findings of the “watershed band” of the Achilles tendon.J Foot Ankle Surg. 2001; 40: 132-136
- Results of chronic Achilles tendinopathy surgery on elite and nonelite track athletes.Foot Ankle Int. 2003; 24 (erratum: Foot Ankle Int 24:951, 2003): 712-720
- Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study.Br J Sports Med. 2002; 36: 178-182
- Operative treatment of chronic Achilles tendinopathy.Int Orthop. 2003; 27: 307-310
- Surgical decompression of chronic central core lesions of the Achilles tendon.Am J Sports Med. 1999; 27: 747-752
- Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients.Clin J Sport Med. 2006; 16: 123-128
- Surgery for chronic Achilles tendinopathy produces worse results in women.Disabil Rehabil. 2008; 30: 1714-1720
- Etiologic factors associated with symptomatic Achilles tendinopathy.Foot Ankle Int. 2006; 27: 952-959
- Multiple percutaneous longitudinal tenotomies for chronic Achilles tendinopathy in runners: a long-term study.Am J Sports Med. 2013; 41: 2151-2157
- Minimally invasive paratenon release for non-insertional Achilles tendinopathy.Foot Ankle Int. 2009; 30: 680-685
- Clinical and functional outcomes of gastrocnemius recession for chronic Achilles tendinopathy.Foot Ankle Int. 2016; 37: 1091-1097
- Isolated gastrocnemius recession for Achilles tendinopathy: strength and functional outcomes.J Bone Joint Surg Am. 2015; 97: 99-105
- Flexor hallucis tendon transfer with an interference screw for chronic Achilles tendinosis: a report of 62 cases.Foot Ankle Spec. 2008; 1: 280-287
- An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer.Foot Ankle Int. 2005; 26: 691-697
- Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1362-1366
- Plantaris excision reduces pain in midportion Achilles tendinopathy even in the absence of plantaris tendinosis.Orthop J Sports Med. 2016; 4 (2325967116673978)
- Minimally invasive for chronic mid-portion Achilles tendinopathy.Dis Rehab. 2008; 30: 1709-1713
- Surgical treatment of chronic Achilles tendinitis.Am J Sports Med. 1989; 17: 754-759
- Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.Int J Surg. 2015; 24: 154-159
Published online: May 31, 2017
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Surgery for Tendinopathy of the Main Body of the Achilles Tendon: No Need to Look for New Solutions When the “Old Ones” Work, if Performed WellThe Journal of Foot and Ankle SurgeryVol. 56Issue 5