Bipolar Radiofrequency Microtenotomy for Chronic Achilles Tendinosis

Does additional extracorporeal shock wave therapy improve the effect of isolated percutaneous radiofrequency coblation in patients with insertional Achilles tendinopathy? Study protocol for a randomized controlled clinical trial

BACKGROUND

No conclusive evidence recommends a prior treatment for insertional Achilles tendinopathy (IAT). It is theorized that both percutaneous radiofrequency coblation and extracorporeal shockwave therapy (ESWT) relieve pain within the insertion. However, no clinical evidence shows that either treatment promotes the regeneration of the tendon or if the combination of these 2 interventions offers better function and less pain than one therapy.

METHODS

The study is a randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients with insertional Achilles tendinopathy who are not satisfied with the effect of conservative treatment will be screened. A minimum of 38 patients will be enrolled after deciding to participate in the trial on an informed basis. Then the intervention group and the control group perform radial ESWT and sham-ESWT respectively at 6 months after percutaneous radiofrequency coblation. The primary outcome will be the Victorian Institute of Sports Assessment Achilles (VISA-A) Score. Secondary outcome measures will be Foot and Ankle Outcome Score (FAOS) scale, visual analog scale (VAS), Tegner Score, and MRI ultra-short echo time (UTE) T2* value. The assessments will occur in 6 months, 1 year, and 2 years, post-operatively. The differences between the 2 groups will be conducted as intention-to-treat basis.

DISCUSSION

We aim to investigate if radiofrequency coblation associated with ESWT can provide more encouraging imaging findings as well as functional and clinical outcomes regarding the treatment of the IAT comparing to the single radiofrequency coblation treatment.

TRIAL REGISTRATION

ChiCTR1800017898; pre-results. Registered on 20 August 2018.

Radiofrequency Microdebridement Versus Surgical Decompression for Achilles Tendinosis: A Randomized Controlled Trial

Achilles tendinosis is primarily managed nonoperatively with activity modification and physiotherapy, although surgery can be required. This has classically involved surgical decompression of the Achilles tendon, although the use of radiofrequency microdebridement has been suggested as a novel minimally invasive alternative. We present a randomized controlled trial comparing radiofrequency microdebridement using the Topaz^® microdebrider wand and traditional surgical decompression. All patients with Achilles tendinosis referred to a single surgeon and meeting the inclusion criteria were invited to participate in our single-blinded, randomized controlled study. The Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire and the visual analog scale were used as measures at baseline and 6 months postoperatively. From 2009 to 2014, 16 patients were randomized to traditional decompression treatment and 20 to Topaz^® treatment. All surgical procedures were performed as day-case procedures with the patient under general anesthetic by a single surgeon. No significant differences were found between the groups in demographic data. At 6 months after intervention, both groups demonstrated an improvement in the Victorian Institute of Sports Assessment-Achilles and visual analog scale scores compared with baseline, with no difference found between treatment modalities at 6 months. The Topaz^® microdebrider resulted in variable outcomes after surgery and is not without complications. Regarding the patient-reported outcome measures, Topaz^® conferred no additional benefit compared with traditional surgical decompression and we have stopped using Topaz^® in our treatment of Achilles tendinosis.

Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis

BACKGROUND

Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF.

METHODS

Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations.

RESULTS

There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations.

CONCLUSIONS

RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications.

Case study: Epidermoid cyst following percutaneous Topaz coblation for plantar fasciitis

An epidermoid cyst is formed when there is proliferation of epidermal cells within an area of the dermis. They may be formed by the traumatic implantation of epidermal cells within the dermis as well as many other mechanisms. We present a case of epidermoid cyst formation following Topaz coblation for plantar fasciitis; a complication we believe is yet to be reported in the literature.

Fascial incision and adhesiolysis combined with radiofrequency microtenotomy in treatment of chronic midportion Achilles tendinopathy

BACKGROUND AND AIMS

Achilles tendinopathy is a common problem that can cause disturbing symptoms in activities of daily living as well as prevent sports activities. The purpose of this study was to evaluate the effects of fascial incision and adhesiolysis combined with radiofrequency microtenotomy in treatment of chronic midportion Achilles tendinopathy.

MATERIAL AND METHODS

Twenty-four patients were included in this study. The cases were studied retrospectively. The mean age of the patients was 54 years (range, 39 to 72) and there were 12 women and 12 men. A final evaluation was done at an average of 30 months (range, 18 to 45) after surgery, including radiofrequency microtenotomy.

RESULTS

In all cases the Nirschl Pain Phase Scale of Athletic Overuse Injuries score improved and the difference was statistically significant (p < 0.0001). The patients themselves rated the result excellent in 14 cases and good in 10 cases.

CONCLUSION

Fascial incision and adhesiolysis combined with radiofrequency microtenotomy seems to be a useful alternative in treatment of chronic midportion Achilles tendinopathy in cases of unsuccessful non-operative treatment.