Operative Management of Noninsertional Tendinosis: Indications and Current Treatment

Noninsertional Achilles tendinopathy is a degenerative condition caused by chronic mechanical overload, commonly affecting athletes and active individuals. While nonoperative treatment is preferred, approximately one-third of cases require surgery. Various surgical options exist, including debridement, tendon scraping, paratenon release, and flexor hallucis longus transfer, with open and minimally invasive techniques yielding comparable outcomes. The condition's pathophysiology remains unclear, complicating treatment standardization. Given the lack of high-quality comparative studies, surgical approaches should be individualized based on patient factors and surgeon expertise. Future research correlating histopathological findings with clinical outcomes may help refine management strategies.