title: Plantaris Excision and Ventral Paratendinous Scraping for Achilles Tendinopathy in an Athletic Population.
abstract: BACKGROUND
  Achilles tendinopathy is a frequent problem in high-level athletes. Recent research has proposed a combined etiologic role for the plantaris tendon and neovascularization. Both pathologies can be observed on ultrasound imaging.(1,13) However, little is known about the change in structure of the Achilles tendon following the surgical treatment of these issues. The purpose of the study was to assess if excising the plantaris and performing ventral paratendinous "scraping" of the neovascularization improved symptoms of Achilles tendinopathy and whether there was a change in the fibrillar structure of the tendon with ultrasound tissue characterization (UTC) following this operation.
  
  
  METHODS
  This prospective consecutive case series included 15 professional/semiprofessional athletes (17 Achilles tendons) who underwent plantaris excision and paratendinous scraping to treat noninsertional Achilles tendinopathy. The plantaris tendon was excised if adherent to the Achilles tendon, and the area of neovascularization for scraping was demarcated on preoperative imaging. Preoperative and postoperative Victorian Institute of Sports Assessment-Achilles (VISA-A) scores were taken. UTC was performed on 11 of 17 tendons preoperatively and postoperatively. The mean follow-up was for 25 months.
  
  
  RESULTS
  Fourteen of 15 patients had a successful outcome after the surgery. The mean VISA-A improved from 51 to 95 (p=.0001). There was a statistically significant (p=.04) improvement in the aligned fibrillar structure of the tendon confirmed with UTC scanning following surgery from 90% (±8) to 96% (±5).
  
  
  CONCLUSIONS
  This group of high-level athletes derived an excellent clinical result from this operation. Furthermore, UTC scanning offered an objective method to evaluate the healing of Achilles tendons.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: OrthoSport Victoria, Richmond, Victoria, Australia.
authors.forename: Harvinder S
authors.initials: HS
authors.lastname: Bedi
authors.affiliation: Foot and Ankle fellow, The Alfred Hospital, Melbourne, Victoria, Australia charliejowett@hotmail.com.
authors.forename: Charlie
authors.initials: C
authors.lastname: Jowett
authors.affiliation: The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Stavros
authors.initials: S
authors.lastname: Ristanis
authors.affiliation: Monash Tendon Research group (MONSTERs), Monash University, Victoria, Australia; Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Docking
authors.affiliation: LaTrobe University, Victoria, Australia.
authors.forename: Jill
authors.initials: J
authors.lastname: Cook
mesh_terms: D000125:Achilles Tendon / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D056352:Athletes; D003475:Curettage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D011446:Prospective Studies; D052256:Tendinopathy / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D055815:Young Adult
keywords: non-insertional Achilles tendinopathy; plantaris tendon; tendon structure; ultrasound tissue characterization (UTC)