title: Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniques.
abstract: BACKGROUND
  Treatment based on ultrasound (US) and colour Doppler (CD) findings in midportion Achilles tendinosis has shown promising results. In a randomised study on a small patient material, similar short-term clinical results were demonstrated with surgery outside the tendon and sclerosing polidocanol injections, but surgical treatment led to a faster return to activity.
  
  
  OBJECTIVE
  To evaluate the clinical results of US and CD-guided mini-surgery (scraping) outside the ventral tendon in a larger patient material and, in a randomised study, compare two different techniques for surgical scraping.
  
  
  METHODS
  103 patients (66 men, 37 women), mean age 43 years (range 24-77), with midportion tendinosis in 125 Achilles tendons were included. Patients from a large group (88 tendons), and a randomised study (37 tendons), were in local anaesthesia treated with a US and CD-guided new surgical approach outside the ventral tendon. All patients in the large group, and one arm of the randomised study, were treated open with a scalpel, while the other arm of the randomised study were treated percutaneously. Pain during Achilles tendon loading activity (Visual Analogue Scale (VAS)), and satisfaction with treatment, were evaluated.
  
  
  RESULTS
  Before surgery, the mean VAS was 73. After surgery (follow-up mean 18 months, range 6-33), the mean VAS was 3 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity. In the randomised study, there were no significant differences in the results between open treatment with a scalpel and percutaneous treatment with a needle.
  
  
  CONCLUSIONS
  US and CD-guided scraping show good short-term results in midportion Achilles tendinosis.
authors.affiliation: Department of Surgical and Perioperative Science Sports Medicine, University of Umeå, Sweden. hakan.alfredson@idrott.umu.se
authors.forename: Håkan
authors.initials: H
authors.lastname: Alfredson
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010149:Postoperative Pain / Q000209:etiology; D011998:Recreation; D013177:Sports / Q000502:physiology; D052256:Tendinopathy / Q000601:surgery*; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D016138:Walking / Q000502:physiology; D055815:Young Adult