Purpose of the study: We reviewed a series of 52 cases of chronic Achilles tendinopathy treated surgically by release of the fascia cruris, resection of peritendon, longitudinal incision of the tendon and occasional excision of intratendinous lesions.

Materials and methods: The mean course prior to surgery was about 18 months. Twenty-six patients practiced sports. Complaints were bilateral in 12 cases. Pain was always present. 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 assessed 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 closely related to amyotrphy. The presence of a foot deformity does not appear to have an unfavorable influence on outcome. The Achilles tendon must not be infiltrated. Ultrasound is highly contributive, but MRI provides a more accurate analysis.

Conclusion: Surgical treatment of chronic Achilles tendinopathies can be proposed when conservative treatment has been unsuccessful. Outcome is better in young active patients and in cases where paratendinitis predominates.

Purpose: We report a series of 52 chronic Achilles tendinopathies. Surgical treatments included peritendon dissection, release of the fasia cruris, limited blunt combing of the tendon, and resection of nodules, calcifications and cysts as needed.

Material and methods: Mean duration of disease before treatment was 18 months. Twenty-six patients had sports activities. There were 12 bilateral cases. Pain was present in all cases. Ultrasonography was used to establish the PUDDU classification: paratendinitis 21, tendinitis 22, paratendinitis with tendinitis 9. All patients were reviewed at two years. Clinical criteria were used to assess outcome.

Results: Mean follow-up was five years six months. Complete pain relief was achieved in 29 cases. Motion was normal in 48 with recovery of former sports level in 29. Overall outcome was very good in 29, good in 14, fair in six and poor in three.

Discussion: The mean age of patients with poor outcome was relatively high. All the poor results were correlated with amyotrophy. The presence of a foot deformity did not appear to have an unfavourable effect on outcome. Infitration of the Achilles tendon should be avoided. Avoiding immobilisation appears to prevent tibiotalar stiffness. Ultrasonography can distinguish paratendinitis, tendinitis and paratendinitis with tendinitis but MRI offers very precise images of the lesions.

Conclusion: Surgical treatment of chronic Achiles tendinopathy can be proposed after failure of medical treatment. Outcome is better in younger subjects who participate in sports activities and who have paratendinitis.