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 …