TITLE:
Ultrasound and Color Doppler-Guided Surgery for Insertional Achilles Tendinopathy-Results of a Pilot Study
AUTHORS:
Håkan Alfredson, Martin Isaksson
KEYWORDS:
Insertional; Achilles; Tendinopathy; Bursitis; Haglund’s Deformity; Ultrasound + Doppler
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.4 No.1,
January
2,
2014
ABSTRACT:
Background: Treatment of insertional achilles tendinopathy is known to be
difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy
have been proposed as the primary treatments for this condition, but surgery is
indicated after failed conservative management. There is no consensus about the
most efficient surgical treatment. Objectives: To evaluate a new ultrasound and
color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean
age 47 years) with a long duration of insertional achilles tendon pain (median
18 months) were included in the study. The surgical procedure consisted of
extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the
ventral distal achilles tendon and removal of prominent bone at the upper
calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris
tendon was also cut and excised. VAS for pain during activity, satisfaction
with the treatment result and the SF-36 score to measure quality of life were
used for evaluation. Results: The mean VAS had decreased
from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were
satisfied with the result and had returned to full tendon loading activity at
the one-year follow-up. The SF-36 score had improved significantly. Conclusion:
Ultrasound and color Doppler-guided surgical treatment seems to be a good
method for treatment of chronic painful insertional achilles tendinopathy.
Longer follow-up studies on larger materials are needed.