Open debridement of noninsertional achilles tendinopathy

Abstract

Although symptomatic Achilles tendinopathy can be managed nonoperatively, histologic analysis of tissue obtained at the time of surgery demonstrates degenerative fibrous tissue, no inflammatory cells, and no healing response. Surgical management of noninsertional Achilles tendinopathy is indicated when nonoperative management fails. Surgical options for noninsertional Achilles tendinopathy include the following: 1. Percutaneous tenotomy 2. Tenosynovectomy 3. Open Achilles debridement with repair of the residual Achilles tendon 4. Open Achilles debridement with reconstruction of the residual Achilles tendon Percutaneous tenotomy can be applied to any case of Achilles tendinopathy, but is perhaps best reserved for mild-to-moderate Achilles tendinopathy. Open debridement affords a comprehensive evaluation and debridement of the diseased Achilles tendon, with the option for augmentation of the repair or reconstruction, and includes tenosynovectomy in virtually all cases. Following debridement, Achilles tendon repair is generally recommended when 50% or more of the cross-sectional volume of the diseased tendon segment comprises healthy tendon fibers. In contrast, reconstruction or augmentation is typically warranted when the majority of the segment in question is diseased. In approximately 19% to 23% of the cases, a partial rupture of the Achilles tendon will be identified at the segment of tendon in question. In a majority of cases, the partial rupture is associated with degenerated/unhealthy tissue. Repair of the partial rupture should be performed in conjunction with excision of the degenerated portion of tendon. © Springer Science+Business Media, LLC 2009.