Purpose: Choronic tendinopathy of the Achilles tendon is frequent. Conservative treatment is long and difficult. Surgical treatment is indicated when response to medical treatment is unsatisfactory. The purpose of this study was to assess at different times and according to the type of tendinopathy treated, the results of our open surgical technique.
Material and methods: We performed a retrospective analysis of 154 cases of Achilles tendonopathiy in 136 patients (104 men and 32 women) operated between March 1985 and October 1997. Mean age was 35.5 years (range 16–70). The majority of the patients (n=146) practised sports regularly (120 at a competition level). These patients had not responded to prolonged medical treatment (mean duration of prior treatment 33.4 months, range 3 months – 15 years) and had invalidating conditions according to the Blazina scale (72 grade III-A and 82 grade III-B). We had 78 cases of insertion tendionpathy (59 without desinsertion, 19 with partial des-insertion), 49 cases of body tendinopathy (32 nodular, 17 non-nodular), 16 partial tears, and 11 cases of isolated peritendinitis. The standard surgical technique consisted in resection of the peritendinous sheath and tendon combing. Depending on the injuries observed, we associated resection of nodules, tendon reinforcement, resection of the calcaneum, or bursectomy.
Results: The overall results were classed excellent (renewed sports activity at former level without pain), good (renewed sports activity at a slightly lower level), or poor (no improvement). Results of 110 cases with more than 43 months follow-up were evaluated at one year, three years, and last follow-up (7.1 years, range 43 months–147 months). Overall results were unchanged for the different assessment times and were, at last follow-up: excellent 70%, good 18.2%, poor 11.8%. Early local complications were observed in 40/154 cases (late healing in 18, haematomas in 12, skin necrosis in 6, and infection in four).
Discussion: The overall results were satisfactory and persisted over time. The final prognosis depends basically on the type of tendinopathy with better results being obtained for isolated peritendinitis and body tendinopathy.
