Background Purpose of this systematic review was (i) to provide means of judgement to assess the benefits and tradeoffs related with different surgical treatments for midportion Achilles tendinopathy and (ii) to highlight possible alternative treatments for Achilles tendinopathy in cases when conservative treatments fail to reach patient satisfaction.

Methods To identify studies about surgical treatment of patients with mid-portion Achilles tendinopathy, MEDLINE, Cochrane Database and Google databases (1945 till November 2012) were searched. After excluding several articles due to our selection criteria, the remaining articles were analyzed and evaluated using the Coleman Methodology Score. Additionally, success rate and the complication rate were determined.

Results Seven studies met our inclusion criteria. These reports evaluated five different operative techniques. A total of 353 tendons were treated in 347 patients with open or minimally invasive techniques. The mean patient satisfaction was 71.4% (range 48% to 100%). The mean rate of minor complications was 4.6% (range 0% to 9.5%). The average of major complications was 3.3% (rang 0% to 14%). The studies assessing minimally invasive techniques reported an average success rate of 62% (range 49% to 75%), 2.7%, minor complications (range 0% to 8%), and no major complications. The open invasive procedures show an average success rate of 78% (range 52% to 86%), a minor complication rate of 6% (range 0% to 9.5%), and a major complication rate of 5.8% (range 0% to 12%).

Conclusions All investigated operative methods were demonstrated to improve patients's conditions, though success rates varied between operative techniques. The complication rate differs between used techniques. Minimal invasive operative techniques seem to be related with fewer complications but open techniques report on higher success rates. Results vary between subjects according to sex and activity level.