MRI findings one year post-radio frequency ablation for chronic Achilles tendonosis: A case report

Abstract

Achilles tendinosis has numerous possible etiologies including overuse, decreased tendon blood supply and tensile strength due to aging, muscle imbalance or weakness, and excessive pronation of the foot. The pathology of tendonosis is not completely understood yet there are many theories described throughout literature. If conservative therapy fails, surgical intervention is indicated. Open surgical debridement of the damaged areas of the Achilles tendon with or without tissue graft and tendon transfers has been the standard of care for many years. Within several studies, there has been reported TOPAZ radiofrequency ablation as a successful and effective method for the treatment of chronic Achilles tendinopathy similar to its use for plantar fasciitis in the lower extremity. This case study focuses on the comparing MRI findings of the Achilles tendon prior to radiofrequency ablation versus 13 months postoperatively. A VAS analog pain score was used pre-operatively and post-operatively for an accurate measurement of pain reduction. The objective measurement of pain was based on pain on palpation along the watershed area of the Achilles tendon on physical examination as well as return to daily life activities. Utilizing this treatment modality described below, no signal intensity changes were not present on follow up MRI within the Achilles tendon. Following surgery, there was reduced thickening of the Achilles tendon at the watershed area on physical exam. The patients pre-operative pain symptoms completely resolved. TOPAZ radiofrequency ablation is an effective method for the treatment of Achilles tendonosis and should be considered prior to performing a more invasive surgical procedure.