Original Research| Volume 56, ISSUE 5, P938-942, September 2017

Minimally Invasive Achilles Tendon Stripping for the Management of Tendinopathy of the Main Body of the Achilles Tendon


      Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively (p < .001). After a mean follow-up period of 40.5 months, 41 patients had resumed sporting activities at an average of 3.5 months postoperatively. A sural nerve injury was recorded in 5 patients (10.6%), and all 5 complications occurred during the first 12 cases. As a result, the technique was slightly modified, and no sural nerve neuropathy was observed subsequently. One superficial infection (2.1%) was recorded. Minimally invasive Achilles tendon stripping seems to be an effective, technically simple, and inexpensive treatment of Achilles tendinopathy. Further randomized controlled trials involving more patients are needed to confirm these outcomes.

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        • Maffulli N.
        • Sharma P.
        • Luscombe K.L.
        Achilles tendinopathy: aetiology and management.
        J R Soc Med. 2004; 97: 472-476
        • Freedman B.R.
        • Gordon J.A.
        • Soslowsky L.J.
        The Achilles tendon: fundamental properties and mechanisms governing healing.
        Muscles Ligaments Tendons J. 2014; 14: 245-255
        • Weinreb J.H.
        • Sheth C.
        • Apostolakos J.
        • McCarthy M.B.
        • Barden B.
        • Cote M.P.
        • Mazzocca A.D.
        Tendon structure, disease, and imaging.
        Muscles Ligaments Tendons J. 2014; 8: 66-73
        • Maffulli N.
        • Giai Via A.
        • Oliva F.
        Chronic Achilles tendon disorders: tendinopathy and chronic rupture.
        Clin Sports Med. 2015; 34: 607-624
        • Longo U.G.
        • Ronga M.
        • Maffulli N.
        Achilles tendinopathy.
        Sports Med Arthrosc. 2009; 17: 112-116
        • Loppini M.
        • Maffulli N.
        Conservative management of tendinopathy: an evidence-based approach.
        Muscles Ligaments Tendons J. 2012; 1: 134-137
        • Tol J.L.
        • Spiezia F.
        • Maffulli N.
        Neovascularization in Achilles tendinopathy: have we been chasing a red herring?.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1891-1894
        • Van Sterkenburg M.N.
        • van Dijk C.N.
        Mid-portion Achilles tendinopathy: why painful? An evidence-based philosophy.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1367-1375
        • Giai Via A.
        • Papa G.
        • Oliva F.
        • Maffulli N.
        Curr Phys Med Rehabil Rep. 2016; 4: 50
        • Alfredson H.
        • Ohberg L.
        • Forsgren S.
        Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 334-338
        • Knobloch K.
        The role of tendon microcirculation in Achilles and patellar tendinopathy.
        J Orthop Surg Res. 2008; 30: 18
        • Kristoffersen M.
        • Ohberg L.
        • Johnston C.
        • Alfredson H.
        Neovascularisation in chronic tendon injuries detected with colour Doppler ultrasound in horse and man: implications for research and treatment.
        Knee Surg Sports Traumatol Arthrosc. 2005; 13: 505-508
        • Ohberg L.
        • Lorentzon R.
        • Alfredson H.
        Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation.
        Knee Surg Sports Traumatol Arthrosc. 2001; 9: 233-238
        • Ohberg L.
        • Alfredson H.
        Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment.
        Br J Sports Med. 2002; 36: 173-175
        • Maffulli N.
        • Spiezia F.
        • Longo U.G.
        • Denaro V.
        • Maffulli G.D.
        High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon.
        Phys Ther Sport. 2013; 14: 163-167
        • Silbernagel K.G.
        • Brorsson A.
        • Lundberg M.
        The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up.
        Am J Sports Med. 2011; 39: 607-613
        • Maffulli N.
        • Longo U.G.
        • Oliva F.
        • Ronga M.
        • Denaro V.
        Minimally invasive surgery of the Achilles tendon.
        Orthop Clin North Am. 2009; 40: 491-498
        • Maffulli N.
        • Longo U.G.
        • Denaro V.
        Novel approaches for the management of tendinopathy.
        J Bone Joint Surg Am. 2010; 92: 2604-2613
        • Longo U.G.
        • Ramamurthy C.
        • Denaro V.
        • Maffulli N.
        Minimally invasive stripping for chronic Achilles tendinopathy.
        Disabil Rehabil. 2008; 30: 1709-1713
        • Maffulli N.
        • Pintore E.
        • Petricciuolo F.
        Arthroscopic wounds: to suture or not to suture.
        Acta Orthop Belg. 1991; 57: 154-156
        • Robinson J.M.
        • Cook J.L.
        • Purdam C.
        • Visentini P.J.
        • Ross J.
        • Maffulli N.
        • Taunton J.E.
        • Khan K.M.
        • Victorian Institute of Sport Tendon Study Group
        The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy.
        Br J Sports Med. 2001; 35: 335-341
        • Paavola M.
        • Orava S.
        • Leppilahti J.
        • Kannus P.
        • Järvinen M.
        Chronic Achilles tendon overuse injury: complications after surgical treatment: an analysis of 432 consecutive patients.
        Am J Sports Med. 2000; 28: 77-82
        • Metz R.
        • van der Heijden G.J.
        • Verleisdonk E.J.
        • Kolfschoten N.
        • Verhofstad M.H.
        • van der Werken C.
        Effect of complications after minimally invasive surgical repair of acute Achilles tendon ruptures: report on 211 cases.
        Am J Sports Med. 2011; 39: 820-824
        • Del Buono A.
        • Volpin A.
        • Maffulli N.
        Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review.
        Br Med Bull. 2014; 109: 45-54
        • Maffulli N.
        • Oliva F.
        • Testa V.
        • Capasso G.
        • Del Buono A.
        Multiple percutaneous longitudinal tenotomies for chronic Achilles tendinopathy in runners: a long-term study.
        Am J Sports Med. 2013; 41: 2151-2157
        • Vega J.
        • Cabestany J.M.
        • Golanó P.
        • Pérez-Carro L.
        Endoscopic treatment for chronic Achilles tendinopathy.
        Foot Ankle Surg. 2008; 14: 204-210
        • Maquirriain J.
        Surgical treatment of chronic Achilles tendinopathy: long-term results of the endoscopic technique.
        J Foot Ankle Surg. 2013; 52: 451-455
        • Pearce C.J.
        • Carmichael J.
        • Calder J.D.
        Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy.
        Foot Ankle Surg. 2012; 18: 124-127
        • Lohrer H.
        • David S.
        • Nauck T.
        Surgical treatment for Achilles tendinopathy—a systematic review.
        BMC Musculoskelet Disord. 2016; 17: 207
        • Baltes T.P.A.
        • Zwiers R.
        • Wiegerinck J.I.
        • van Dijk C.N.
        Surgical treatment for midportion Achilles tendinopathy: a systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1817-1838
        • Khan K.M.
        • Cook J.L.
        • Maffulli N.
        • Kannus P.
        Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin.
        Br J Sports Med. 2000; 34: 81-83