title: Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique.
abstract: OBJECTIVE
  The study aimed to compare two methods of open surgical treatment for midportion Achilles tendinopathy in sportsmen. A novel technique consisting in transferring some soleus fibres into the degenerated tendon to improve its vascularization and longitudinal tenotomies are evaluated and compared.
  
  
  METHODS
  From 2006 to 2011, fifty-two competitive and noncompetitive athletes affected by midportion Achilles tendinopathy were surgically treated and prospectively evaluated at 6 months and at a final 4-year mean follow-up. Twenty patients had longitudinal tenotomies, and thirty-two had soleus fibres transfer. Clinical outcome was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Victorian Institute of Sports Assessment-Achilles (VISA-A) score. Time to return to walk and to run and tendon thickening were also recorded.
  
  
  RESULTS
  Patients in the soleus transfer group had a higher increase in AOFAS and VISA-A score at 6 months and at the mean 4-year final follow-up (by 5.4 points, 95 % CI 2.9-7.9, p < 0.001 and by 5.7 points, 95 % CI 2.5-8.9, p = 0.001, for AOFAS and VISA, respectively). They also needed less time to return to run: 98.9 ± 17.4 days compared to 122.2 ± 26.3 days for the longitudinal tenotomies group (p = 0.0019). The soleus transfer group had a greater prevalence of tendon thickening (59.4 % compared to 30.0 % in the longitudinal tenotomies group, p = 0.037).
  
  
  CONCLUSIONS
  Open surgery for midportion Achilles tendinopathy is safe and effective in medium term. Despite similar outcomes in postoperative functional scores, soleus transfer allows a faster recovery but has a higher incidence of tendon thickening. These results should suggest the use of the soleus graft technique in high-level athletes.
  
  
  METHODS
  Prospective comparative study, Level II.
authors.affiliation: Clinica Ortopedica e Traumatologica, IRCCS Fondazione Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Benazzo
authors.affiliation: Clinica Ortopedica e Traumatologica, IRCCS Fondazione Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanon
authors.affiliation: Servizio di Biometria e Statistica, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Clinica Ortopedica e Traumatologica, IRCCS Fondazione Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy. matteomarullo@hotmail.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Marullo
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D056352:Athletes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000637:transplantation*; D018482:Muscle, Skeletal / Q000637:transplantation*; D011446:Prospective Studies; D000068958:Return to Sport; D052256:Tendinopathy / Q000601:surgery*; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Achilles tendon; Sports traumatology; Surgical Technique; Tendinopathy; Tendon surgery; Tendon vascularization