Surgery for chronic achilles tendonitis

NewsBot · Oct 15, 2009

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Flexor hallucis tendon transfer with an interference screw for chronic achilles tendinosis: a report of 62 cases.
Cottom JM, Hyer CF, Berlet GC, Lee TH.
Foot Ankle Spec. 2008 Oct;1(5):280-7

Chronic disorders of the Achilles tendon are frequently treated by foot and ankle surgeons. A number of surgical techniques have been described for treating chronic degenerative Achilles tendinosis. This is the largest reported series evaluating a method of transferring the flexor hallucis longus (FHL) tendon and securing it with an Arthrex interference screw into the calcaneus. Sixty-two patients with Achilles tendinosis underwent Achilles debridement and transfer of the FHL tendon for chronic conditions when greater than 50% of the tendon was involved. All 62 patients were followed for an average of 26.97 months. A modified American Orthopaedic Foot and Ankle Society score was evaluated both preoperatively and postoperatively and demonstrated significant improvement. Because of the anatomical relationship of the FHL tendon to the Achilles tendon and the fact that both tendons act in the same phase, transfer of this tendon in chronic Achilles tendinosis or rupture is a reasonable option. The described technique is advantageous in that it is simple to perform and is less time-consuming than other reported methods. The authors have had no revisions to date.
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NewsBot · Jan 30, 2010

Endoscopic treatment of chronic mid-portion Achilles tendinopathy: novel technique with short-term results.
Thermann H, Benetos IS, Panelli C, Gavriilidis I, Feil S.
Knee Surg Sports Traumatol Arthrosc. 2009 Oct;17(10):1264-9.

In this prospective study, we present the short-term clinical results of a novel endoscopic surgical technique for patients suffering from chronic painful mid-portion Achilles tendinopathy. Eight consecutive patients (seven men and one woman, mean age 52 years) diagnosed with chronic painful mid-portion Achilles tendinopathy were included in this study and were treated with endoscopic debridement of the ventral neovascularized area, the peritendineum and the Achilles tendon. Patients recorded the function of the Achilles tendon and the severity of Achilles tendon pain during tendon loading activity, pre and postoperatively in a visual analogue scale. Patient global satisfaction was also assessed in a similar manner. Patients were followed-up for 6 months. All patients experienced immediate postoperative pain relief. In terms of Achilles tendon pain, the median visual analogue score (VAS) increased from 40 (10-60) (preoperatively) to 97.5 (85-100) (last follow-up examination). In terms of Achilles tendon function, the median VAS increased from 22.5 (0-30) (preoperatively) to 90 (80-95) (last follow-up examination). In terms of global satisfaction, the median VAS in the last follow-up examination was 85 (70-95). No postoperative complications were recorded. In conclusion, the short-term clinical results were satisfactory.
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NewsBot · Dec 6, 2016

Treatment of Insertional Achilles Pathology With Dorsal Wedge Calcaneal Osteotomy in Athletes
Dimitrios Georgiannos et al
Foot & Ankle International December 5, 2016

Background: Insertional Achilles tendinopathy and retrocalcaneal bursitis is difficult to treat, and several operative techniques have been used after failure of conservative management. Dorsal wedge calcaneal osteotomy has been described for the treatment of insertional Achilles pathology. It was hypothesized that dorsal wedge calcaneal osteotomy would be an effective and safe method for the treatment of athletes with insertional Achilles pathology unrelieved by nonoperative measures.
Methods: Fifty-two athletes (64 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. Dorsally based wedge calcaneal osteotomy was performed through a lateral approach, and 2 staples were used for fixation. Patients were scored pre- and postoperatively with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot and Victorian Institute of Sports of Australia-Achilles (VISA-A) scores.
Results: At a minimum follow-up of 3 years, the patients’ AOFAS and VISA-A scores improved from 59.5 ± 15.0 and 65.9 ± 11.1 preoperatively to 95.7 ± 6.2 and 90.2 ± 8.4 postoperatively, respectively. Clinical results were considered excellent in 38 patients, good in 12 patients, and fair in 2 patients. Return to previous sports activity time was 21 (SD, 8.0) weeks. One patient necessitated a revision operation.
Conclusion: Operative treatment of insertional Achilles pathology in athletes with dorsal closing wedge calcaneal osteotomy was a safe and effective method that allowed for a quicker return to previous level of sports activities compared with other techniques.
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