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Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy


Medicine & Science in Sports & Exercise: April 2002 - Volume 34 - Issue 4 - p 573-580
CLINICAL SCIENCES: Clinical Investigations

TESTA, V., G. CAPASSO, F. BENAZZO, and N. MAFFULLI. Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med. Sci. Sports Exerc., Vol. 34, No. 4, pp. 573–580, 2002.

Purpose To report the middle to long-term results of ultrasound-guided percutaneous longitudinal tenotomy of the Achilles tendon

Method Seventy-five athletes with unilateral Achilles tendinopathy underwent ultrasound-guided percutaneous longitudinal tenotomy under local anesthetic infiltration after failure of conservative management. Sixty-three patients were reviewed at least 36 months after the operation (51 ± 18.2 months).

Results Thirty-five patients were rated excellent, 12 good, 9 fair, and 7 poor. Nine of the 16 patients with a fair or poor result underwent a formal exploration of the Achilles tendon 7–12 months after the index procedure. The operated tendons remained thickened and the ultrasonographic appearance of operated tendons remained abnormal even 8 yr after the operation, without interfering with physical training. Isometric maximal muscle strength and isometric endurance gradually returned to values similar to their contralateral unoperated tendon.

Conclusions Percutaneous longitudinal ultrasound-guided internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. It should be considered in the management of chronic Achilles tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from diffuse or multinodular tendinopathy or from pantendinopathy, a formal surgical exploration with stripping of the paratenon and multiple longitudinal tenotomies may be preferable.

Dynamic Center, Angri, ITALY; Istituto di Clinica Ortopedica, II Università di Napoli, ITALY; Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Ortopedia e Traumatologia, Centro di Studi e Ricerche di Medicina e Traumatologia dello Sport, Università degli Studi di Pavia, I.R.C.C.S.–Policlinico San Matteo, Pavia, ITALY; and Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Hartshill, Stoke on Trent, Staffordshire, UNITED KINGDOM

Submitted for publication March 2001.

Accepted for publication July 2001.

© 2002 American College of Sports Medicine