Summary

By using the VISA-A questionnaire and the VAS scale, together with postoperative MRI we obtained improved functional results and minimal complications in Achilles tendinopathy treated surgically with debridement and plantaris longus augmentation .

Abstract

Introduction

Non-insertional Achilles tendinopathy is a debilitating condition which can impact a patients’ quality of life. When conservative management fails surgical treatment options have demonstrated good but inconsistent results. The most common performed surgical procedure is the longitudinal debridement of the tendon in its affected parts. We hypothesis that following debridement the use of a plantaris longus (PL) augment with repair can provide a more consistent post-surgical result.

Method

19 consecutive patients with Achilles tendinopathy treated with surgical debridement and PL suture augmentation were retrospectively reviewed. All of the selected cases have had chronic, painful Achilles tendinopathy and a minimum of 10 months postoperative follow-up period. The surgical procedure was performed by a standard longitudinal postero-medial approach. The PL tendon is spread out and used to envelop the suture site of the Achilles tendon, thus augmenting the lesion site, protecting it and ensuring a faster and more biologic healing process. The patients were evaluated with the VISA-A questionnaire before surgery and 6 and 24 months post operatively. An MRI scan was obtained at 6 months post-surgery which were reviewed by a blinded board certified radiologist.

Results

The mean follow-up was 18.47 months (10-24). The VISA-A questionnaire showed important increase in postoperative mean values (82, 78-86 and 87, 84-89 p=0.0463) compared to the initial evaluation (46, 41-52). Review of the postoperative MRI showed appropriate and uniform healing of the tendon in all cases (19/19). At final follow-up no then rupture had occurred. The mean VAS at the final follow up was 10 (5-20). There were no post-surgical complications in this series.

Conclusion

Achilles tendinopathy treated with surgical debridement and PL suture augmentation provided an increase in VISA-A score with evidence of PL incorporation at the site of the tendon repair. In this small case series we demonstrate improvement of clinical outcomes with a small complication rate.
Keywords: Achilles tendon, plantaris longus, tendon surgery