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Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniques

Alfredson, Hakan Br J Sports Med 2011;45:407–410. doi:10.1136/bjsm.2010.081216

ABSTRACT

Background Treatment based on ultrasound (US)

and colour Doppler (CD) fi ndings in midportion Achilles

tendinosis has shown promising results. In a randomised

study on a small patient material, similar short-term clinical

results were demonstrated with surgery outside the

tendon and sclerosing polidocanol injections, but surgical

treatment led to a faster return to activity.

Objective To evaluate the clinical results of US and

CD-guided mini-surgery (scraping) outside the ventral

tendon in a larger patient material and, in a randomised

study, compare two different techniques for surgical

scraping.

Material and methods 103 patients (66 men,

37 women), mean age 43 years (range 24–77), with

midportion tendinosis in 125 Achilles tendons were

included. Patients from a large group (88 tendons), and a

randomised study (37 tendons), were in local anaesthesia

treated with a US and CD-guided new surgical approach

outside the ventral tendon. All patients in the large group,

and one arm of the randomised study, were treated open

with a scalpel, while the other arm of the randomised

study were treated percutaneously. Pain during Achilles

tendon loading activity (Visual Analogue Scale (VAS)),

and satisfaction with treatment, were evaluated.

Results Before surgery, the mean VAS was 73. After

surgery (follow-up mean 18 months, range 6–33), the

mean VAS was 3 in 111 tendons (89%) from satisfi ed

patients back in full Achilles tendon loading activity. In

the randomised study, there were no signifi cant differences

in the results between open treatment with a

scalpel and percutaneous treatment with a needle.

Conclusions US and CD-guided scraping show good

short-term results in midportion Achilles tendinosis.