Minimally invasive paratenon release for non-insertional Achilles tendinopathy.
BACKGROUND
Non-insertional Achilles tendinopathy is an increasing, perhaps secondary to an increase in sporting activities. Traditional open surgical procedures have been associated with a significant rate of complications. We describe a minimally invasive technique involving the release of the adherent paratenon with a peritendinous infusion of corticosteroids and present the results in a cohort of patients.


METHODS
Twenty-nine tendons (26 patients) with non-insertional Achilles tendinopathy were treated with the above technique. Assessments were made prospectively using an adapted classification of Achilles tendon disability and a visual analogue scale for pain. Patients were interviewed in person or by telephone at an average of 14 (range, 6 to 30) months after surgery.


RESULTS
The average pain score (VAS) improved from 8.7 to 2.4 (p < 0.001) and the average Puddu level of disability improved from 4.9 to 1.7 (p < 0.001). Seventy-five percent of patients had a good or excellent outcome with 20% having sufficient improvement not to pursue further medical attention for their tendinopathy. There was a 7% rate of minor complications due to delayed wound healing which resolved spontaneously and did not affect the rehabilitation or the recovery of the patients.


CONCLUSIONS
A minimally invasive circumferential paratenon release and peritendinous steroid infusion was a simple method to treat non-insertional Achilles tendinopathy and had low morbidity in our series. This technique has become our preferred primary surgical intervention for this condition.
Naidu
Venunatha
V
Abbassian
Ali
A
Nielsen
Dominic
D
Uppalapati
Raju
R
Shetty
Anupkumar
A
D000125:Achilles Tendon; D000328:Adult; D000368:Aged; D004210:Dissection / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D052256:Tendinopathy / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone