Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy.
OBJECTIVE
To report the middle to long-term results of ultrasound-guided percutaneous longitudinal tenotomy of the Achilles tendon


METHODS
Seventy-five athletes with unilateral Achilles tendinopathy underwent ultrasound-guided percutaneous longitudinal tenotomy under local anesthetic infiltration after failure of conservative management. Sixty-three patients were reviewed at least 36 months after the operation (51 +/- 18.2 months).


RESULTS
Thirty-five patients were rated excellent, 12 good, 9 fair, and 7 poor. Nine of the 16 patients with a fair or poor result underwent a formal exploration of the Achilles tendon 7-12 months after the index procedure. The operated tendons remained thickened and the ultrasonographic appearance of operated tendons remained abnormal even 8 yr after the operation, without interfering with physical training. Isometric maximal muscle strength and isometric endurance gradually returned to values similar to their contralateral unoperated tendon.


CONCLUSIONS
Percutaneous longitudinal ultrasound-guided internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. It should be considered in the management of chronic Achilles tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from diffuse or multinodular tendinopathy or from pantendinopathy, a formal surgical exploration with stripping of the paratenon and multiple longitudinal tenotomies may be preferable.
Testa
Vittorino
V
Dynamic Center, Angri, Italy.
Capasso
Giovanni
G
Benazzo
Franco
F
Maffulli
Nicola
N
D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional