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Where to now with Achilles tendon treatment?
  1. Håkan Alfredson
  1. Correspondence to Dr Håkan Alfredson, Sports Medicine Unit, Department of Surgical and Perioperative Sciences, Umea University, Umea 901 87, Sweden; hakan.alfredson{at}

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The chronic painful midportion Achilles tendon has been difficult to treat for years, and has on occasions ended the career of high-level athletes. Traditionally, when conservative treatments failed these athletes, surgery was instituted. Surgical treatment of midportion Achilles tendinosis consisted of a dorsal approach, with a central longitudinal tenotomy and excision of tendinosis tissue.1,,3 This often required a long postoperative rehabilitation of 3–6 months before that athlete was allowed to retry full tendon-loading activity. The results of intra-tendinous surgery is known to be unpredictable.

With the introduction of painful eccentric training in the late 1990s,4 a high proportion of recreationally active athletes became pain-free, but the treatment was less successful for high-level …

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