Achilles tendinopathy—do plantaris tendon removal and Achilles tendon scraping improve tendon structure? A prospective study using ultrasound tissue characterisation

Abstract

ObjectivesThe plantaris tendon has recently been described as a possible important factor in midportion Achilles tendinopathy. Ultrasound tissue characterisation (UTC) is a method to study tendon structure (matrix integrity). The effect of plantaris tendon removal on Achilles tendon structure was studied using UTC.Design and settingProspective case series study at one centre.ParticipantsNine tendons in eight physically active and healthy patients (mean age 39 years) with chronic painful midportion Achilles tendinopathy were included. Preoperative two-dimensional ultrasound and UTC showed midportion Achilles tendinopathy (tendinosis) with medial tendon changes and suspected plantaris tendon involvement. Patients with previous operations to the Achilles tendon were excluded.InterventionsOperative treatment consisted of excision of the plantaris tendon and scraping of the ventromedial surface of the Achilles tendon under a local anaesthetic.Primary and secondary outcome measuresUTC examination and clinical scoring with the VISA-A questionnaire were performed preoperatively and 6 months postoperatively.ResultsAt 6 months follow-up, UTC demonstrated a statistically significant (t=5.40, p<0.001) increase in the mean organised matrix (echo-type I+II) and a decrease in the mean disorganised matrix (echo-type III+IV). Seven out of eight patients were satisfied, and the VISA-A score had increased significantly (p<0.001) from 56.8 (range 34–73) preoperatively to 93.3 (range 87–100) postoperatively.ConclusionsExcision of the plantaris tendon and scraping of the ventromedial Achilles tendon in chronic midportion tendinopathy seem to have the potential to improve tendon structure and reduce tendon pain. Studies on a larger group of patients and with a longer follow-up period are needed.

The tenocyte phenotype of human primary tendon cells in vitro is reduced by glucocorticoids

“…The tissue was obtained in the course of a previously described surgical procedure that includes plantaris tendon removal and Achilles tendon scraping [7, 45]. The isolation and culturing of primary tendon cells was carried out according to a protocol that has been routinely used in our laboratory [46].…”

Possible effect of morphological variations of plantaris muscle tendon on harvesting at reconstruction surgery-case report

“…Despite extensive research, the pathogenesis is still not fully understood [4]. Nevertheless, clinical studies have shown that removing PM may result in an improvement of the Achilles tendon structure, accompanied by improved clinical VISA-A scores [18], i.e. a quantitative index of pain and function in patients with Achilles tendinopathy.…”

Differential Plantaris‐Achilles Tendon Motion: A Sonographic and Cadaveric Investigation

“…Achilles tendinopathy affects 1‐2 people per 1000 among the general population and up to 10% of elite long‐distance runners [2‐5]. Alfredson et al have recently hypothesized that the plantaris tendon (PT) may contribute to the development or perpetuation of symptomatic Achilles tendinopathy in some patients [6‐14]. The PT typically lies directly adjacent to the Achilles tendon (AT) and although smaller in size, the PT is stronger, stiffer, and less extensible than the AT (Figure 1A‐B) [6,15].…”