Surgical management of Achilles tendinitis

Abstract

Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse problems seen in runners. There are actually several etiologies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalcaneal bursitis seems to be a separate entity with hypertrophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, particularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combination of both. Mean followup was 3 years (range, 1 1/2 to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory outcome as compared with 71% of patients with retrocalcaneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17 degrees preoperatively to a mean of 25 degrees postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.

Tendon pathology in long-standing achillodynia: Biopsy findings in 40 patients

“…Mucoid degeneration has been reported in the Achilles tendon in both ruptures (Amer et al 1959, Kannus andJdzsa 1991) and tendinosis, mostly among athletes (Clancy et al 1976, Puddu et al 1976, Merkel et al 1982, Schepsis and Leach 1987, Nelen et al 1989.…”

Fascial Incision and Adhesiolysis Combined with Radiofrequency Microtenotomy in Treatment of Chronic Midportion Achilles Tendinopathy

“…Satisfactory results have been reported in approximately 80 to 90 per cent of the cases (14)(15)(16). However, in a recent series of patients with chronic Achilles tendinopathy treated surgically it was reported that non-athletic patients experience more prolonged recovery, more complications and are at greater risk for further surgery than athletic patients (17).…”

Shock wave therapy for Achilles tendinopathy

“…However, operative treatment should be considered when a comprehensive nonoperative treatment program of several months' duration has failed and the patient is not willing to alter or abandon the precipitating sports activity [39]. Surgical treatment is required in about 25% of athletes with Achilles tendon overuse injuries [41].…”