Surgical treatment of non-insertional Achilles tendinitis

Heel Complications

Postoperative complications can be burdensome on both the patient and the surgeon. Attention in literature is often directed toward different forms of treatment and successful outcomes in surgery. The incentive of this article is to bring insight toward postoperative complications in rearfoot surgery, more specifically, the repair of the Achilles tendon with suture tape and suture anchors. This article directs attention to the recent reports on hypersensitivity reactions seen with the use of suture tape and nonabsorbable suture anchors and may encourage physicians to make patients aware of this potential complication when using these materials.

Achilles Tendinosis Injuries-Tendinosis to Rupture (Getting the Athlete Back to Play)

Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture.

Surgical Strategies for the Treatment of Insertional Achilles Tendinopathy

Insertional Achilles tendinopathy is one of the most common Achilles tendon disorders and often results in substantial heel pain and functional disability. There is consensus that treatment of insertional Achilles tendinopathy should start with nonoperative modalities. Surgery should be reserved for patients who fail exhaustive conservative treatment for a period of 3 months to 6 months and include débridement of insertional calcifications. Intratendinous degenerative tissue should be débrided and any Haglund deformity resected. Different surgical techniques have been described for reattachment of the distal Achilles tendon. The authors' preferred surgical technique includes the knotless double-row footprint reconstruction. Postoperative complications are not rare.

Retrospective Analysis of the Effectiveness of Platelet-Rich Plasma in the Treatment of Achilles Tendinopathy: Pretreatment and Posttreatment Correlation of Magnetic Resonance Imaging and Clinical Assessment

Platelet-rich plasma (PRP) has been presented as a means of treating Achilles tendinopathy. Over the past dozen years, a plethora of medical articles have advocated this treatment, yet little evidentiary-based research exists in support of this approach. Treatment protocols with PRP have been performed in 2 ways during this time: administered adjunctively during tendon surgery and as a stand-alone injection. The senior author has utilized PRP by both methods to treat Achilles tendinopathy over the past 7 years; 26 patients so treated were able to be recalled, half having undergone Achilles tendon surgery in combination with PRP administration and the other half PRP alone. In this retrospective study, qualified patients had pretreatment and posttreatment magnetic imaging studies and completed a Victorian Institute of Sports Assessment-Achilles questionnaire. In this limited study, PRP showed promise in the treatment of Achilles tendinopathy. Both the stand-alone injection group and surgical/injection groups had statistically significant degrees of improvement in pre-MRI and post-MRI imaging studies. There was no statistically significant difference between the 2 treatment groups. Of interest, it appears that the difference between the MRI scoring correlates with the survey score.

LEVEL OF EVIDENCE

Therapeutic, Level, IV: Case series.

Achilles tendinosis: treatment options

Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options.