Minimally invasive stripping for chronic achilles tendinopathy

Abstract

Achilles tendinopathy is common both in athletic and sedentary individuals, and the incidence has risen in the last few decades. Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its cause, pathology, natural history, and optimal management. The management of Achilles tendinopathy lacks evidence-based support, and tendinopathy sufferers are at risk of long-term morbidity with unpredictable clinical outcome. Most patients respond to conservative treatments. When conservative management is unsuccessful, surgery is recommended. Classically, the aim of surgery was to remove the nodules of failed healed response within the tendon and to excise fibrotic adhesions. Minimally invasive stripping of the AT is a novel surgical procedure which aims to break the neo-vessels and neo-nerves around the tendon which may be the origin of pain in a minimally invasive fashion. Similar results have been reported with both open and minimally invasive techniques. However, minimally invasive techniques appear to reduce the risks of infection and provide better cosmetic results. In this chapter, minimally invasive Achilles tendon stripping and its rationale are described.