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Comparative Study
. 2016 Jun;24(6):1868-76.
doi: 10.1007/s00167-014-3232-x. Epub 2014 Sep 6.

Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique

Francesco Benazzo  1 , Giacomo Zanon  1 , Catherine Klersy  2 , Matteo Marullo  3
Affiliations
Comparative Study

Open surgical treatment for chronic midportion Achilles tendinopathy: faster recovery with the soleus fibres transfer technique

Francesco Benazzo et al. Knee Surg Sports Traumatol Arthrosc. 2016 Jun.

Abstract

Purpose: The study aimed to compare two methods of open surgical treatment for midportion Achilles tendinopathy in sportsmen. A novel technique consisting in transferring some soleus fibres into the degenerated tendon to improve its vascularization and longitudinal tenotomies are evaluated and compared.

Methods: From 2006 to 2011, fifty-two competitive and noncompetitive athletes affected by midportion Achilles tendinopathy were surgically treated and prospectively evaluated at 6 months and at a final 4-year mean follow-up. Twenty patients had longitudinal tenotomies, and thirty-two had soleus fibres transfer. Clinical outcome was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Victorian Institute of Sports Assessment-Achilles (VISA-A) score. Time to return to walk and to run and tendon thickening were also recorded.

Results: Patients in the soleus transfer group had a higher increase in AOFAS and VISA-A score at 6 months and at the mean 4-year final follow-up (by 5.4 points, 95 % CI 2.9-7.9, p < 0.001 and by 5.7 points, 95 % CI 2.5-8.9, p = 0.001, for AOFAS and VISA, respectively). They also needed less time to return to run: 98.9 ± 17.4 days compared to 122.2 ± 26.3 days for the longitudinal tenotomies group (p = 0.0019). The soleus transfer group had a greater prevalence of tendon thickening (59.4 % compared to 30.0 % in the longitudinal tenotomies group, p = 0.037).

Conclusions: Open surgery for midportion Achilles tendinopathy is safe and effective in medium term. Despite similar outcomes in postoperative functional scores, soleus transfer allows a faster recovery but has a higher incidence of tendon thickening. These results should suggest the use of the soleus graft technique in high-level athletes.

Level of evidence: Prospective comparative study, Level II.

Keywords: Achilles tendon; Sports traumatology; Surgical Technique; Tendinopathy; Tendon surgery; Tendon vascularization.

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