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Midsubstance Tendinopathy, Surgical Management
William T DeCarbo1, Mark J Bullock2
1The Orthopedic Group, 800 Plaza Drive, Suite 240, Belle Vernon, PA 15012, USA.
Clinics in Podiatric Medicine and Surgery
|March 5, 2017
Summary
Surgical options for noninsertional Achilles tendinopathy unresponsive to conservative care include paratenon release or excision for paratendinopathy. For core tendinopathy, surgical excision and repair, or tendon transfer for extensive defects, are effective treatments.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Research
Background:
- Noninsertional Achilles tendinopathy frequently requires surgical intervention when conservative treatments fail.
- Accurate diagnosis differentiating paratendinopathy from noninsertional tendinopathy is crucial for effective management.
- Understanding the histopathology, such as collagen synthesis by myofibroblasts in paratendinopathy, guides surgical approaches.
Purpose of the Study:
- To outline surgical strategies for managing noninsertional Achilles tendinopathy and associated paratendinopathy.
- To provide guidance on distinguishing between paratendinopathy and noninsertional tendinopathy in clinical practice.
- To describe specific surgical techniques, including tendon repair and tendon transfer, for complex cases.
Main Methods:
- Review of surgical techniques for Achilles tendinopathy and paratendinopathy.
- Description of diagnostic considerations, including Magnetic Resonance Imaging (MRI) for identifying core tendinopathy.
- Detailed explanation of surgical procedures: paratenon release/excision, longitudinal excision of tendinopathic core, side-to-side suture repair, flexor hallucis longus tendon transfer, and gastrocnemius aponeurosis turndown flap.
Main Results:
- Paratendinopathy can be managed by releasing or excising the affected paratenon.
- Surgical excision of the tendinopathic core, followed by side-to-side repair, is indicated for identified core lesions.
- For resections exceeding 50% of tendon diameter, flexor hallucis longus tendon transfer is recommended.
- Gastrocnemius aponeurosis turndown flap offers a viable reconstructive option with positive outcomes.
Conclusions:
- Surgical intervention provides effective solutions for refractory noninsertional Achilles tendinopathy and paratendinopathy.
- Tailored surgical approaches based on accurate diagnosis and extent of tendon involvement yield favorable results.
- Advanced techniques like tendon transfer and flap reconstruction address significant tendon defects.
