Purpose: To present a minimally invasive technique for the management of chronic Achilles tendinopathy (AT).
Methods: Four longitudinal skin incisions each 0.5 cm long are made. Two incisions are made just medial and lateral to the origin of the tendon; the other two incisions are made just medial and lateral to the distal end of the tendon close to its insertion. A mosquito is inserted in the incisions, and the proximal and distal portions of Achilles tendon are freed of all the peritendinous adhesions. A Number 1 unmounted Ethibond (Ethicon, Somerville, NJ) suture thread is inserted proximally, passing through the two proximal incisions over the anterior aspect of the Achilles tendon. The Ethibond is retrieved from the distal incisions, over the anterior aspect of the Achilles tendon. The Ethibond is slid on the tendon, which in this way is stripped and freed from adhesions. The procedure is repeated for the posterior aspect of the Achilles tendon. In addition, longitudinal percutaneous tenotomies parallel to the tendon fibers can be performed, if necessary.
Conclusions: This technique has the advantages of achieving a safe and secure disruption of neo-vessels and the accompanying nerve supply in a minimally invasive fashion.
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Alfredson H, Ohberg L. Neovascularisation in chronic painful patellar tendinosis–promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatol Arthrosc. 2005;13:74–80.PubMedCrossRefGoogle Scholar
Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003;11:334–338.PubMedCrossRefGoogle Scholar
Knobloch K, Kraemer R, Lichtenberg A, et al. Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med. 2006;34:92–97.PubMedCrossRefGoogle Scholar
Kristoffersen M, Ohberg L, Johnston C, et al. Neovascularisation in chronic tendon injuries detected with colour Doppler ultrasound in horse and man: implications for research and treatment. Knee Surg Sports Traumatol Arthrosc. 2005;13:505–508.PubMedCrossRefGoogle Scholar
Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80:188–201.PubMedGoogle Scholar
Longo UG, Ramamurthy C, Denaro V, Maffulli N. Minimally invasive stripping for chronic Achilles tendinopathy. Disabil Rehabil. 2008;30(20-22):1709–13.CrossRefGoogle Scholar
Maffulli N, Kenward MG, Testa V, et al. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med. 2003;13:11–15.PubMedCrossRefGoogle Scholar
Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004;97:472–476.PubMedCrossRefGoogle Scholar
Maffulli N, Testa V, Capasso G, et al. Results of percutaneous longitudinal tenotomy for Achilles tendinopathy in middle- and long-distance runners. Am J Sports Med. 1997;25:835–840.PubMedCrossRefGoogle Scholar
Maffulli N, Testa V, Capasso G, et al. Similar histopathological picture in males with Achilles and patellar tendinopathy. Med Sci Sports Exerc. 2004;36:1470–1475.PubMedCrossRefGoogle Scholar
Maffulli N, Testa V, Capasso G, et al. Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients. Clin J Sport Med. 2006;16:123–128.PubMedCrossRefGoogle Scholar
Maffulli N, Almekinders LC. The Achilles Tendon. New York, NY: Springer; 2007:83–92.Google Scholar
Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med. 2002;36:173–175, discussion 6–7.PubMedCrossRefGoogle Scholar
Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc. 2001;9:233–238.PubMedCrossRefGoogle Scholar
Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport. 2007;10:52–58.PubMedCrossRefGoogle Scholar
Testa V, Capasso G, Benazzo F, et al. Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exerc. 2002;34:573–580.PubMedCrossRefGoogle Scholar
Willberg L, Sunding K, Ohberg L, et al. Treatment of Jumper’s knee: promising short-term results in a pilot study using a new arthroscopic approach based on imaging findings. Knee Surg Sports Traumatol Arthrosc. 2007;15:676–681.PubMedCrossRefGoogle Scholar