Open Debridement of Noninsertional Achilles Tendinopathy

  • Mark E Easley
  • Ian L.D Le
Although symptomatic Achilles tendinopathy can be managed nonoperatively, 1, 2 histologic analysis of tissue obtained at the time of surgery demonstrates degenerative fibrous tissue, no inflammatory cells, and no healing response. 3, 4 Surgical management of noninsertional Achilles tendinopathy is indicated when nonoperative management fails. Surgical options for noninsertional Achilles tendinopathy include the following:
  1. 1.

    Percutaneous tenotomy

  2. 2.


  3. 3.

    Open Achilles debridement with repair of the residual Achilles tendon

  4. 4.

    Open Achilles debridement with reconstruction of the residual Achilles tendon

Percutaneous tenotomy can be applied to any case of Achilles tendinopathy, but is perhaps best reserved for mild-to-moderate Achilles tendinopathy. 5, 6, 7Open debridement affords a comprehensive evaluation and debridement of the diseased Achilles tendon, with the option for augmentation of the repair or reconstruction, and includes tenosynovectomy in virtually all...


Achilles Tendon Achilles Tendinopathy Flexor Hallucis Longus Open Debridement Diseased Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ohberg L, Alfredson H. 2004; Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc 12:(5)465–70.PubMedCrossRefGoogle Scholar
  2. 2.
    Ohberg L, Lorentzon R, Alfredson H. 2004; Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med 38:(1)8–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Rel Res 1995;(316):151–64.Google Scholar
  4. 4.
    Maffulli N, Kader D. 2002; Tendinopathy of tendo achillis. J Bone Joint Surg [Br] 84:(1)1–8.CrossRefGoogle Scholar
  5. 5.
    Maffulli N, Testa V, Capasso G,. et al. 1997; Results of percutaneous longitudinal tenotomy for Achilles tendinopathy in middle- and long-distance runners. Am J Sports Med 25:(6)835–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Testa V, Capasso G, Benazzo F,. et al. 2002; Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exerc 34:(4)573–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Testa V, Maffulli N, Capasso G,. et al. 1996; Percutaneous longitudinal tenotomy in chronic Achilles tendonitis. Bull Hosp Joint Dis 54:(4)241–4.Google Scholar
  8. 8.
    Astrom M. 1998; Partial rupture in chronic Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand 69:(4)404–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Maffulli N, Wong J, Almekinders LC. 2003; Types and epidemiology of tendinopathy. Clin Sports Med 22:(4)675–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Astrom M, Gentz CF, Nilsson P,. et al. 1996; Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 25:(7)615–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Karjalainen PT, Soila K, Aronen HJ,. et al. 2000; MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol 175:(1)251–60.PubMedGoogle Scholar
  12. 12.
    Gardin A, Bruno J, Movin T,. et al. 2006; Magnetic resonance signal, rather than tendon volume, correlates to pain and functional impairment in chronic Achilles tendinopathy. Acta Radiol 47:(7)718–24.PubMedCrossRefGoogle Scholar
  13. 13.
    Shalabi A, Kristoffersen-Wilberg M, Svensson L,. et al. 2004; Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med 32:(5)1286–96.PubMedCrossRefGoogle Scholar
  14. 14.
    Johnston E, Scranton P Jr, Pfeffer GB. 1997; Chronic disorders of the Achilles tendon: results of conservative and surgical treatments. Foot Ankle Int 18:(9)570–4.PubMedGoogle Scholar
  15. 15.
    Lehtinen A, Peltokallio P, Taavitsainen M. 1994; Sonography of Achilles tendon correlated to operative findings. Ann Chir Gynaecol 83:(4)322–7.PubMedGoogle Scholar
  16. 16.
    Paavola M, Paakkala T, Kannus P,. et al. 1998; Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. A comparison between pre-operative ultrasonography and surgical findings. Acta Radiol 39:(6)612–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Shalabi A, Kristoffersen-Wiberg M, Papadogiannakis N,. et al. 2002Dynamic contrast-enhanced MR imaging and histopathology in chronic Achilles tendinosis. A longitudinal MR study of 15 patients. Acta Radiol;43:(2)198–206.PubMedGoogle Scholar
  18. 18.
    Wapner KL, Pavlock GS, Hecht PJ,. et al. 1993; Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 14:(8)443–9.PubMedGoogle Scholar
  19. 19.
    Tashjian RZ, Hur J, Sullivan RJ,. et al. 2003; Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int 24:(9)673–6.PubMedGoogle Scholar
  20. 20.
    Khan RJ, Fick D, Keogh A,. et al. 2005; Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg [Am] 87:(10)2202–10.CrossRefGoogle Scholar
  21. 21.
    Paavola M, Orava S, Leppilahti J,. et al. 2000; Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med 28:(1)77–82.PubMedGoogle Scholar
  22. 22.
    Pajala A, Kangas J, Ohtonen P,. et al. 2002; Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg [Am] 84–A:(11)2016–21.Google Scholar
  23. 23.
    Chiodo CP, Wilson MG. 2006; Current concepts review: acute ruptures of the Achilles tendon. Foot Ankle Int 27:(4)305–13.PubMedGoogle Scholar
  24. 24.
    Martin RL, Manning CM, Carcia CR,. et al. 2005; An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer. Foot Ankle Int 26:(9)691–7.PubMedGoogle Scholar
  25. 25.
    Wilcox DK, Bohay DR, Anderson JG. 2000; Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation. Foot Ankle Int 21:(12)1004–10.PubMedGoogle Scholar
  26. 26.
    Coull R, Flavin R, Stephens MM. 2003; Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int 24:(12)931–4.PubMedGoogle Scholar
  27. 27.
    Tallon C, Coleman BD, Khan KM,. et al. 2001; Outcome of surgery for chronic Achilles tendinopathy. A critical review. Am J Sports Med 29:(3)315–20.Google Scholar
  28. 28.
    Maffulli N, Testa V, Capasso G,. et al. 2006; Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients. Clin J Sport Med 16:(2)123–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Benazzo F, Stennardo G, Valli M. 1996; Achilles and patellar tendinopathies in athletes: pathogenesis and surgical treatment. Bull Hosp Joint Dis 54:(4)236–40.Google Scholar
  30. 30.
    Maffulli N, Binfield PM, Moore D,. et al. 1999; Surgical decompression of chronic central core lesions of the Achilles tendon. Am J Sports Med 27:(6)747–52.PubMedGoogle Scholar
  31. 31.
    Ohberg L, Lorentzon R, Alfredson H. 2001; Good clinical results but persisting side-to-side differences in calf muscle strength after surgical treatment of chronic Achilles tendinosis: a 5-year follow-up. Scand J Med Sci Sports 11:(4)207–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Leach RE, Schepsis AA, Takai H. Long-term results of surgical management of Achilles tendinitis in runners. Clin Orthop Rel Res 1992;(282):208–12.Google Scholar
  33. 33.
    Saxena A, Cheung S. 2003; Surgery for chronic Achilles tendinopathy. Review of 91 procedures over 10 years. J Am Podiatr Med Assoc 93:(4)283–91.PubMedGoogle Scholar
  34. 34.
    Saxena A. 2003; Results of chronic Achilles tendinopathy surgery on elite and nonelite track athletes. Foot Ankle Int 24:(9)712–20.PubMedGoogle Scholar
  35. 35.
    Schepsis AA, Jones H, Haas AL. 2002; Achilles tendon disorders in athletes. Am J Sports Med 30:(2)287–305.PubMedGoogle Scholar
  36. 36.
    Paavola M, Kannus P, Orava S,. et al. 2002; Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study. Br J Sports Med 36:(3)178–82.PubMedCrossRefGoogle Scholar
  37. 37.
    Alfredson H, Pietila T, Lorentzon R. 1996:Chronic Achilles tendinitis and calf muscle strength. Am J Sports Med 24(6)829–33.PubMedCrossRefGoogle Scholar
  38. 38.
    Alfredson H, Pietila T, Ohberg L,. et al. 1998; Achilles tendinosis and calf muscle strength. The effect of short-term immobilization after surgical treatment. Am J Sports Med 26:(2)166–71.PubMedGoogle Scholar
  39. 39.
    Gould N, Korson R. 2002; Stenosing tenosynovitis of the pseudosheath of the tendo Achilles. Foot Ankle Int 23:(7)595–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Mark E Easley
    • 1
  • Ian L.D Le
  1. 1.Division of Orthopaedic SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations