Achilles Tendon Scraping With Plantaris Tendon Removal for Achilles Tendinopathy: A Systematic Review and Meta-analysis.

Abstract

Background: Achilles tendinopathy (AT) patients who are refractory or have a suboptimal response to traditional tendon loading rehabilitation may have an additional component of pain with the plantaris tendon. This systematic review aims to evaluate the efficacy and safety of the combination of Achilles tendon scraping (ATS) and plantaris tendon removal (PTR) for AT.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Embase, and Cochrane Library for studies reporting on concurrent ATS with PTR for AT. Study variables included the number of patients, mean age, mean follow-up time, return to activity (RTA) or sport (RTS), pre- and postintervention patient-reported outcomes (PROs), and complications. A meta-analysis was performed for pre- and postintervention Victorian Institute of Sports Assessment-Achilles (VISA-A) scores.

Results: Seven studies including 235 patients (291 tendons) with a mean age of 40.8 years (27.2-52) and a mean follow-up time of 23.2 months (6-69.6) were analyzed. Mean preoperative score VISA-A (5 studies), and visual analog scale (VAS) scores (2 studies) were 43.4 (0-74.1) and 6.6 (5.8-7.4), respectively. RTA (1 study) and RTS (4 studies) were 100% and 95.5%. Mean postoperative VISA-A and VAS scores were 92.7 (61-100) and 0.8 (0.8-0.8). Pooled VISA-A mean differences were statistically significant at 43.6 (95% CI: 41.0-46.3, P < .00001). The complication and revision rates were 11 (3.8%) and 5 (1.7%), respectively.

Conclusion: ATS with PTR demonstrated promising preliminary results, with improved postoperative PROs, high reported rates of RTA/RTS, and low complication and revision rates. These findings should be interpreted cautiously given the limited available evidence and high study heterogeneity.