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. 2020 Jun 9;6(1):e000769.
doi: 10.1136/bmjsem-2020-000769. eCollection 2020.

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone-a case series

Håkan Alfredson  1   2 , Christoph Spang  3   4
Affiliations

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone-a case series

Håkan Alfredson et al. BMJ Open Sport Exerc Med. .

Abstract

Background: Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.

Methods: Eleven patients (eight men and three women) with a mean age of 44 years (range 24-62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.

Results: At follow-up 21 (median, range 12-108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0-52) to 91 (range 33-100) (p<0.01).

Conclusion: In patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.

Level of evidence: IV Case series.

Keywords: Achilles; lower limb surgery; tendinopathy; tendon.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Longitudinal greyscale ultrasound+colour Doppler view: high blood flow in the subcutaneous bursa overlaying the bone formations in the distal tendinopathic Achilles.
Figure 2
Figure 2
Surgical removal of the subcutaneous bursa.
See this image and copyright information in PMC

References

    1. Myerson MS, McGarvey W. Disorders of the insertion of the Achilles tendon and Achilles tendinitis. J Bone Joint Surg Am 1998;80A:1814–24.
    1. Kearney R, Costa ML. Insertional Achilles tendinopathy management: a systematic review. Foot Ankle Int 2010;31:689–94. 10.3113/FAI.2010.0689 - DOI - PubMed
    1. Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, et al. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2013;21:1345–55. 10.1007/s00167-012-2219-8 - DOI - PubMed
    1. Stenson JF, Reb CW, Daniel JN, et al. Predicting failure of Nonoperative treatment for insertional Achilles tendinosis. Foot Ankle Spec 2018;11:252–5. 10.1177/1938640017729497 - DOI - PubMed
    1. Maffulli N, Testa V, Capasso G, et al. Calcific insertional Achilles tendinopathy: reattachment with bone anchors. Am J Sports Med 2004;32:174–82. 10.1177/0363546503258923 - DOI - PubMed