title: Surgical treatment for midportion Achilles tendinopathy: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to systematically evaluate the available literature on surgical treatment for midportion Achilles tendinopathy and to provide an overview of the different surgical techniques.
  
  
  METHODS
  A systematic review of the literature available in MEDLINE, EMBASE and the Cochrane database of controlled trials was performed. The primary outcome measure in terms of patient satisfaction and the secondary outcome measures that consisted of complication rate, pain score, functional outcome score and success rate were evaluated. The Downs & Black checklist and the Coleman methodology scale were used to assess the methodological quality of included articles.
  
  
  RESULTS
  Of 1090 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 1285 procedures in 1177 patients. The surgical techniques were divided into five categories. Eleven studies evaluated open surgical debridement, seven studies described minimally invasive procedures, three studies evaluated endoscopic procedures, one study evaluated open gastrocnemius lengthening, and one study reported on open autologous tendon transfer. Results regarding patient satisfaction (69-100 %) and complication rate (0-85.7 %) varied widely.
  
  
  CONCLUSIONS
  This study demonstrates the large variation in surgical techniques available for treatment of midportion Achilles tendinopathy. None of the included studies compared surgical intervention with nonsurgical or placebo intervention. Minimally invasive and endoscopic procedures yield lower complication rates with similar patient satisfaction in comparison with open procedures. Minimally invasive and endoscopic procedures might therefore prove to be the future of surgical treatment of Achilles midportion tendinopathy.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. t.p.baltes@amc.uva.nl.
authors.forename: T P A
authors.initials: TPA
authors.lastname: Baltes
authors.affiliation: Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Zwiers
authors.affiliation: Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: J I
authors.initials: JI
authors.lastname: Wiegerinck
authors.affiliation: Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: C N
authors.initials: CN
authors.lastname: van Dijk
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D057189:Checklist; D003646:Debridement; D004724:Endoscopy; D006801:Humans; D018482:Muscle, Skeletal / Q000601:surgery; D017060:Patient Satisfaction; D052256:Tendinopathy / Q000601:surgery*; D013709:Tendon Transfer
keywords: Endoscopic surgery; Midportion Achilles tendinopathy; Minimally invasive surgery; Open surgery; Tenotomies