title: Midsubstance Tendinopathy, Surgical Management.
abstract: Noninsertional Achilles tendinopathy often responds to nonoperative treatment. When nonoperative treatment fails, the clinician must distinguish between paratendinopathy and noninsertional tendinopathy. In paratendinopathy, myofibroblasts synthesize collagen, causing adhesions, and the paratenon may be released or excised. If a core area of tendinopathy is identified on MRI, the area is excised longitudinally and repaired with a side-to-side suture. If greater than 50% of the tendon diameter is excised, the authors recommend a short flexor hallucis longus tendon transfer with an interference screw. A turndown flap of the gastrocnemius aponeurosis is also described with good results.
authors.affiliation: The Orthopedic Group, 800 Plaza Drive, Suite 240, Belle Vernon, PA 15012, USA. Electronic address: wdecarbo@yahoo.com.
authors.forename: William T
authors.initials: WT
authors.lastname: DeCarbo
authors.affiliation: Saginaw Valley Bone and Joint Center, 5483 Gratiot Road, Saginaw, MI 48638, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bullock
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome
keywords: Achilles paratendinopathy; Achilles peritendinitis; Achilles tendinopathy; Achilles tendinosis; Flexor hallucis longus transfer; Noninsertional achilles