Surgical treatment of non-insertional Achilles tendinopathy: Comparison of endoscopic and open approaches.

Abstract

Introduction: Non-insertional Achilles tendinopathy is a common condition, and endoscopic treatment is becoming an increasingly important therapeutic option. The aim of our study was to compare functional and anatomical results between open and endoscopic surgical treatment of non-insertional Achilles tendinopathy.

Hypothesis: Endoscopic surgery provides better functional results and faster recovery than open surgery.

Method: A multicenter non-randomized prospective study included all adult patients operated on for non-insertional Achilles tendinopathy resistant to medical treatment. Clinical evaluation was based on EFAS and VISA-A scores and return to sport.

Results: Sixty patients were included, 22 of whom underwent endoscopic surgery and 38 open surgery. Skin healing was later following endoscopic surgery. No nerve damage was reported. There were no differences in functional scores between the two approaches. Walking was resumed before 6 weeks. Return to sport was progressive as of month 3 and achieved in 80% of cases by month 6, without significant difference according to approach.

Discussion: Surgical management of non-insertional tendinopathy refractory to medical treatment presented low morbidity, allowed early resumption of walking by 6 weeks and return to sport in 80% of cases by month 6, but only a third of cases at the previous level. Results were comparable between endoscopic and open approaches.

Level of evidence: III.