Surgical treatment for midportion Achilles tendinopathy: a systematic review

Abstract

PurposeThe aim of this study was to systematically evaluate the available literature on surgical treatment for midportion Achilles tendinopathy and to provide an overview of the different surgical techniques.MethodsA systematic review of the literature available in MEDLINE, EMBASE and the Cochrane database of controlled trials was performed. The primary outcome measure in terms of patient satisfaction and the secondary outcome measures that consisted of complication rate, pain score, functional outcome score and success rate were evaluated. The Downs & Black checklist and the Coleman methodology scale were used to assess the methodological quality of included articles.ResultsOf 1090 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 1285 procedures in 1177 patients. The surgical techniques were divided into five categories. Eleven studies evaluated open surgical debridement, seven studies described minimally invasive procedures, three studies evaluated endoscopic procedures, one study evaluated open gastrocnemius lengthening, and one study reported on open autologous tendon transfer. Results regarding patient satisfaction (69–100 %) and complication rate (0–85.7 %) varied widely.ConclusionsThis study demonstrates the large variation in surgical techniques available for treatment of midportion Achilles tendinopathy. None of the included studies compared surgical intervention with nonsurgical or placebo intervention. Minimally invasive and endoscopic procedures yield lower complication rates with similar patient satisfaction in comparison with open procedures. Minimally invasive and endoscopic procedures might therefore prove to be the future of surgical treatment of Achilles midportion tendinopathy.Level of evidenceIV.

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments

“…A total of 25 systematic reviews assessing 228 RCTs and enrolling over 15 000 patients met all inclusion criteria and were included in the study (Table 1). 29‐53 The CCA was 1.14% indicating minimal overlap across the 25 included systematic reviews. Of the 228 individual studies across the 25 systematic reviews, 173 were unique, 38 were repeated in 2 primary reviews, while 6 were repeated in 3 primary reviews, 4 were repeated in 4 primary reviews, 5 studies were repeated in 5 primary reviews, and 1 was repeated in 7 primary reviews (Data ).…”

Posterior heel pain

“…27,28 Complication rates are, in small series, reported to be lower with minimally invasive techniques than with open surgery, with comparable patient satisfaction. 29 Insertional Achilles tendinopathy Non-operative management: this condition can be difficult to manage non-operatively, since symptoms are likely to be exacerbated by aggressive stretching exercises. It is therefore important to identify those patients with insertional pain before referring for physiotherapy.…”

Editorial Commentary: The Amsterdam Achilles Tendinopathy Endoscopic Treatment: Should We Start Booking Our Patients for Surgery?

“…In their discussion, the authors suggested peritendinous neovascularization as the main pain generator and recommended plantaris resection based on their previous studies and recognized continuing controversy in the literature. 2 Tol and others have previously challenged this theory and described other sources of Achilles pain generation. 3,4 Finally, the authors concluded that this endoscopic treatment has resulted in good functional outcomes and a high satisfaction rate in the enrolled patients, although 46% of their patients had partial pain relief and 14% would not have the surgery again.…”