Radiofrequency Microtenotomy or Physical Therapy for Achilles Tendinopathy: Results of a Randomized Clinical Trial

Abstract

Background: Achilles tendinopathy is a painful disorder, and various treatment options are available. Bipolar radiofrequency microtenotomy (RFM) has shown promising results in treating tendinosis. Purpose/Hypothesis: The purpose was to compare the results between treatment with bipolar RFM and physical therapy (PT) for patients with midportion Achilles tendinopathy. It was hypothesized that RFM would be equivalent or superior to PT. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 38 patients with midportion Achilles tendinopathy were evaluated for 2 years. The patients were randomized to receive either RFM or PT. There were 20 patients in the RFM group and 18 patients in the PT group. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the Foot and Ankle Outcome Score (FAOS). The degree of tendinosis was evaluated with magnetic resonance imaging (MRI) of the affected ankle performed before intervention and 2 years after intervention. Results: In both groups, the VAS scores at the 2-year follow-up were significantly improved compared with preintervention: from 7.2 ± 1.5 to 1.0 ± 1.4 for the RFM group and from 5.9 ± 1.3 to 3.1 ± 1.8 for the PT group ( P < .01 for both). Compared with the PT group, the RFM group had significantly better VAS scores at both the 1- and 2-year follow-ups ( P < .01 for both) and better scores on 4 of the 5 FAOS subscales at the 2-year follow-up ( P < .01 for all). MRI revealed an improvement in the tendinosis score in both groups, without any significant difference between the groups. Conclusion: In this randomized study, the clinical assessments revealed significant improvements in the VAS, FAOS, and tendinosis score as seen on MRI 2 years after intervention with either RFM or PT in patients with midportion Achilles tendinopathy. The improvement was significantly better in the RFM group with regard to VAS and FAOS, but not in the MRI appearance. Registration: NCT03274557 ( ClinicalTrials.gov identifier).

Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy

“…During the full-text review, 40 studies were excluded for the following reasons: 20 articles used the wrong comparator; 9 were conference proceedings; 5 were not RCTs; 4 had the wrong patient population (insertional AT); and 2 used the wrong outcome measures (tendon stiffness and range of motion). Thus, 12 RCTs ¶ (N = 543 participants) were included in the systematic review and 10 RCTs 1 , 5 , 6 , 10 , 19 , 22 , 37 – 39 , 55 (n = 486 participants) in the meta-analyses.…”

“…The characteristics of included studies and their participants are presented in Table 1 . The population in the included trials were adults aged 18 to 75 years, with either subacute (<3 months; 2 studies 54 , 55 ) or chronic (≥3 months; 10 studies 1 , 5 , 6 , 10 , 19 , 22 , 37 - 39 , 47 ) symptoms. Nine RCTs compared an eccentric loading protocol with a passive treatment modality and 3 RCTs compared different loading protocols.…”

“…Studies comparing the standard Alfredson protocol with another active intervention used heavy slow resistance exercises, the Silbernagel protocol 19 (daily dose of concentric, eccentric, and plyometric loading of the Achilles tendon), and a “do-as-tolerated” Alfredson protocol. Ten studies 1 , 5 , 6 , 10 , 19 , 22 , 37 - 39 , 54 used a 12-week exercise intervention period while only 1 study 55 used an 8-week and 1 study 47 used a 6-week exercise intervention period. Nine studies used the VAS, while 9 studies used the VISA-A.…”

“…Another possible reason explaining the short-term pain decrease associated with passive modalities is that, while resorting to those passive treatments, patients may be asked to rest or minimize the load applied to the tendon so as not to aggravate the symptoms. 1 , 37 , 38 Since tendinopathy and its associated symptoms are often due to overuse, this early discharge period could be favorable to short-term pain reduction, unlike exercise loading protocols that aim to gradually increase stress induced on tendons. Thus, one might expect a slight transient increase in pain with protocols such as the Alfredson.…”

Endoscopic Calcaneoplasty With Bony Debridement and Radiofrequency

“…Application of Topaz radiofrequency application has also been shown to have good outcomes in treating Achilles tendinopathy. 16 , 17 Topaz radiofrequency therapy in addition to calcaneoplasty can be considered for the treatment of Haglund’s syndrome, although there have been reports of complications such as tendon rupture and delayed relief, and long-term data are currently still lacking ( Table 2 ). 18 …”