Endoscopic surgery of the Achilles tendon

Abstract

The value of endoscopic surgery as a minimally invasive treatment is well recognized and includes less perioperative pain, less scarring, minimal blood loss, and faster recovery. While open surgery on the Achilles tendon is notorious for wound complications, the tendon is situated in a well-formed tunnel allowing surgical procedures to be performed endoscopically. Various endoscopic techniques have been successfully applied to the treatment of non-insertional Achilles tendinopathy, Haglund's syndrome, Achilles tendon rupture, and equinus contracture. Although the evidence is currently limited, results from authors acquainted with the techniques have been encouraging. Both an understanding of surgical anatomy of the hindfoot and familiarity in soft tissue endoscopy are required to achieve successful outcomes while minimizing complications.

Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture

“…Achilles tendoscopy has been developed with the main indication of denervation of the painful area of the tendinopathic tendon by releasing the paratenon from the Achilles tendon 4 5 16–18…”

“…The patient was put in a prone position and a thigh tourniquet was applied to provide a bloodless surgical field. Achilles tendoscopy4 5 was performed with dorsomedial and dorsolateral portals at the sides of the Achilles tendon close to its insertion (figure 2) and 4.0 mm 30° arthroscope was used for this procedure. The non-scarred distal part of the tendon was identified and then traced proximally to the scarred part of the tendon.…”

Non-insertional Achilles tendinopathy

“…Promising initial 108 and even longer-term results (mean seven year follow-up) with no complications have been reported for endoscopic paratenon debridement and longitudinal tenotomies. 109,110 …”

Achilles Tendoscopy for Non-Insertional Tendinopathy

“…The Achilles tendon is the most important motor unit of the lower leg and strongest tendon in the human body [1], it is composed of the Gastrocnemius and Soleus muscles, and it is lined by a paratenon which is divided into two layers: parietal and visceral. The tendon rotates 90˚ so that the Soleus portion inserts anteromedial in the calcaneal tuberosity while the Gastrocnemius portion inserts posterolateral.…”