Minimally Invasive Paratenon Release for Non-Insertional Achilles Tendinopathy

Abstract

A minimally invasive circumferential paratenon release and peritendinous steroid infusion was a simple method to treat non-insertional Achilles tendinopathy and had low morbidity in our series. This technique has become our preferred primary surgical intervention for this condition.

Surgical treatment for midportion Achilles tendinopathy: a systematic review

“…16 (19)B. Minimally invasive: US–CD-guided release ventral AT by use of a needle Alfredson [1] a 72 (88)Minimally invasive: US–CD-guided release ventral AT3014 Alfredson et al [3]13 (13)Minimally invasive: US–CD-guided release ventral AT4617 Calder et al [6]32 (34)Minimally invasive: Release AT and excision plantaris tendon5921 Maffulli et al [20]39 (39)Minimally invasive: multiple percutaneous longitudinal tenotomies5920 Naidu et al [24]26 (29)Minimally invasive: circumferential AT release with a tracheal hook + peritendinous infusion of corticosteroids4017 Testa et al [36]63 (63)Minimally invasive: multiple US-guided percutaneous longitudinal tenotomies6520Endoscopic procedures Maquirriain [22]24 (27)Endoscopic: debridement paratenon + two longitudinal tenotomies5213 Pearce et al [30]11 (11)Endoscopic: debridement paratenon + release of plantaris tendon6013 Steenstra and van Dijk [33]16 (16)Endoscopic: debridement paratenon + release of plantaris tendon2611Open surgery: gastrocnemius lengthening Duthon et al [10]13 (15)Open surgery: gastrocnemius lengthening6515Open surgery: autologous tendon transfer Martin et al [23]44 (4...…”

“…15/19 (78.9 %)B. 4/19 (21.1 %) Alfredson [1] a,b 81/88 (92.0 %)7/88 (8.0 %) Alfredson et al [3]11/13 (84.6 %)2/13 (15.4 %) Calder et al [6] c 22/32 (69 %)10/32 (31 %) Maffulli et al [20]30/39 (76.9 %)9/39 (23.1 %) Naidu et al [24] c 24/26 (92 %)2/26 (7.7 %) Testa et al [36]47/63 (74.6 %)16/63 (25.4 %)Endoscopic procedures Maquirriain [22] c 24/24 (100 %) Pearce et al [30]8/11 (73 %)3/11 (27 %) Steenstra and van Dijk [33]Open surgery: gastrocnemius lengthening Duthon et al [10] c 12/13 (92.3 %)1/13 (7.7 %)Open surgery: autologous tendon transfer Martin et al [23]37/44 (86 %)6/44 (13.8 %) a Same study comparing release of ventral AT with knife versus needle b Study includes patients who received bilateral surgical treatment; outcome reported on individual tendons c Study included patients who received bilateral surgical treatment; outcome reported on patient level …”

“…[1–3, 6, 24]. Complications rates were adequately reported in four studies, ranging from 2.9 up to 30.6 % (Table 3) [2, 6, 24, 36].…”

“…With new insights into the aetiology of tendinopathy, new surgical procedures were developed, resulting in a large variety of surgical techniques [19, 34]. Because of the high complication rates in open procedures, less invasive techniques gained popularity [16, 24, 29, 37]. …”

Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique

“…Moreover, Naidu et al [30] reported a complication rate of 7 %, mainly due to delayed wound healing.…”