Surgical treatment of Achilles tendiopathies: a review of 52 cases

Purpose of the study We reviewed a series of 52 cases of chronic Achilles tendinopathy treated s urgically by release of the fascia cruris, resection of peritendon, longitu dinal incision of the tendon and occasional excision of intratendinous lesi ons. Materials and methods The mean course prior to surgery was about 18 months. Twenty-six patients p racticed sports. Complaints were bilateral in 12 cases. Pain was always pre sent. Ultrasound exploration evidenced paratendinitis (n = 21), tendinosis (n = 22) and paratendinitis with tendinosis (n = 9) (Puddu classification). Patients were reviewed after a minimal 2-year follow-up. Results were asse ssed on the basis of clinical findings. Results Mean follow-up was 5 years 6 months. Twenty-nine patients were free of pain . The range of motion was normal in 48 cases and 29 patients resumed sports activities at the same level as prior to surgery. Outcome was very good in 29 patients, good in 14 average in 6 and poor in 3. Discussion Stiffness of the tibio-tarsal joint can be avoided by proper mobilization. Outcome appears to be better in middle-aged patients. Poor outcome is close ly related to amyotrphy. The presence of a foot deformity does not appear t o have an unfavorable influence on outcome. The Achilles tendon must not be infiltrated. Ultrasound is highly contributive, but MRI provides a more ac curate analysis. Conclusion Surgical treatment of chronic Achilles tendinopathies can be proposed when conservative treatment has been unsuccessful. Outcome is better in young ac tive patients and in cases where paratendinitis predominates.