Endoscopic Application of a Collagen Scaffold for Treatment of Achilles Tendinopathy

This technical note explores Achilles tendinopathy treatment, focusing on the endoscopic application of a bioinductive collagen scaffold, a different approach to this prevalent condition. Indications include symptoms of midportion Achilles tendinopathy that have not responded to nonsurgical treatment. A co-axial 2-portal Achilles tendoscopy using a 30° 4-mm arthroscope is performed with the patient in a prone position. The procedure involves standard Achilles tendoscopic debridement and adhesiolysis, followed by the scaffold’s introduction through the proximal portal in a rolled-up state; this bioinductive collagen scaffold is then unfolded arthroscopically and on-laid over the tendinopathy site under tendoscopic visualization. The bioinductive scaffold is then anchored with soft-tissue anchors, after which the portal incision can be closed and the patient rehabilitated according to standard protocol. This technique is notable, as it negated the need for an open incision and instead uses endoscopy for the application of this collagen scaffold which can be a stand-alone treatment option for Achilles tendinopathy; or used in conjunction with other minimally invasive Achilles tendon treatment procedures such as an endoscopic flexor hallucis longus transfer.