Surgical treatment of chronic Achilles tendinitis

Abstract

Between 1977 and 1985, 170 patients suffering from chronic Achilles tendinitis were treated surgically. Ninety-one patients with 143 tendons returned for followup. The duration of preoperative symptoms averaged 18 months. In all cases, conservative treatment was first attempted but failed to alleviate symptoms. Only those patients whose lesions and symptoms were confined to the Achilles tendon segment 2 to 6 cm proximal of the insertion were included in this study. All athletes who had an insertion tendinopathy or a lesion at the musculotendinous junction were excluded from this study. The surgical procedure depended on the lesion. For 93 tendons exhibiting pure peritendinitis, treatment consisted of a simple release of the fascia cruris and the peritenon. For the 50 tendons with tendinosis, a resection of diseased tendon tissue was performed. The defect could be sutured side to side in 26 cases but in the other 24 cases, reinforcement with a turned down tendon flap was necessary because of the extensive debridement. Of the 93 cases in which only dorsal release was performed, results were considered excellent in 54 cases, good in 28, fair in 8, and poor in 3 cases. Of the 26 cases in which side-to-side suture was performed, 15 cases were rated as having excellent results, 4 as good, 4 as fair, and 3 as poor. For the 24 cases in which a turned down tendon flap procedure was performed, the result was excellent in 12 cases, good in 9, fair in 2, and poor in 1 case.(ABSTRACT TRUNCATED AT 250 WORDS)

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

“…When studying Achilles tendon injuries in athletes, Kvist (1991) found that the mean age of subjects with Achilles tendon disorders was 28±9 years, while it was 20±8 years in those without these disorders. Treatment studies (both surgical and non-surgical), that not only include athletes, report that the average age of patients with Achilles tendinopathy ranges between 30 and 55 years, with a total range from 17-80 years of age (Nelen et al, 1989, Leach et al, 1992, NiesenVertommen et al, 1992, Schepsis et al, 1994, Alfredson et al, 1998b, Alfredson et al, 1998c, Angermann and Hovgaard, 1999, Paavola et al, 2000a, Paavola et al, 2000b, Mafi et al, 2001, Öhberg and Alfredson, 2002, Paavola et al, 2002b, Neeter et al, 2003, Alfredson and Öhberg, 2005d. In a prospective study, Johansson (1986) reported that the annual incidence of Achilles tendon overuse injury in elite orienteers was 7%.…”

“…One study reports that 89% of the runners with Achilles tendinopathy were men (Kvist, 1991). In a review of several treatment studies, the percentage of men was between 45-86%, with the lower percentages seen in the more recent studies (Nelen et al, 1989, Schepsis et al, 1994, Alfredson et al, 1998b, Alfredson et al, 1998c, Angermann and Hovgaard, 1999, Paavola et al, 2000a, Paavola et al, 2000b, Mafi et al, 2001, Öhberg and Alfredson, 2002, Paavola et al, 2002b, Alfredson and Öhberg, 2005d.…”

“…Instead, many studies use patient-reported pain (on a Visual Analog Scale) with tendon loading activity as a main outcome measure to determine the success of treatment. Sometimes, it is the investigator that grades the success of treatment based on patient-reported improvements (Clement et al, 1984, Lowdon et al, 1984, Nelen et al, 1989, Leach et al, 1992, Niesen-Vertommen et al, 1992, Schepsis et al, 1994, Alfredson et al, 1998b, Angermann and Hovgaard, 1999, Paavola et al, 2000b, Mafi et al, 2001, Testa et al, 2002, Öhberg and Alfredson, 2002, Alfredson and Lorentzon, 2003a, Gill et al, 2004, Koenig et al, 2004, Paoloni et al, 2004, Öhberg et al, 2004b, Costa et al, 2005, Alfredson and Öhberg, 2005d.…”

“…It is not clear why surgery sometimes helps and the post-operative rehabilitation may be as important as the actual surgery (Khan et al, 1999). The success rates for surgery are reported to be approximately 70-80% (Nelen et al, 1989, Leach et al, 1992, Schepsis et al, 1994, Tallon et al, 2001, Paavola et al, 2002a, Paavola et al, 2002b, Alfredson and Öhberg, 2005c. In a review of the outcome of surgery for chronic Achilles tendinopathy, a negative correlation was found between reported success rates and overall method scores (Tallon et al, 2001).…”

“…It is also reported, in the 8-year follow-up, that 41% of the patients developed symptoms on the previously uninjured side (Paavola et al, 2000a). The success rates for surgery are reported to be approximately 70-80% (Nelen et al, 1989, Leach et al, 1992, Schepsis et al, 1994, Tallon et al, 2001, Paavola et al, 2002a, Paavola et al, 2002b, Alfredson and Öhberg, 2005c. Today fewer patients may need surgery due to improved non-surgical treatment, such as exercise treatment.…”