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Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
  1. Håkan Alfredson1,
  2. Christoph Spang2,
  3. Sture Forsgren2
  1. 1Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, Umeå, Sweden
  2. 2Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Sture Forsgren, Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå SE 901 87, Sweden; Sture.Forsgren{at}Anatomy.Umu.Se

Abstract

Background Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis.

Objectives To evaluate the outcome of surgery for Achilles tendinopathy.

Methods This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6–120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined.

Results Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally.

Conclusion Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.

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