Introduction For many years midportion Achilles tendinopathy was known to be difficult to treat. Recent advances using immunohistochemical analyses of tissue specimens have clarified the neural patterns in this condition, and new treatment approaches focusing on the blood vessel and nerve rich ventral side of the Achilles have shown good clinical results.

Material 125 tendons from 103 patients (66 males, and 37 females).

Methods Ultrasound (US)+Doppler (CD)-guided scraping in local anaesthesia. Clinical and US+DP follow-ups.

Results Follow-ups at 18 months (mean) showed good clinical results in 111/125 tendons, VAS from 73 to 3.

US follow-ups have shown a thinner tendon with improved structure.

Discussion Surgical scraping treatment on the blood vessel and nerve rich ventral side of the Achilles midportion has a high potential to reduce tendon pain and also to improve tendon structure and decrease tendon thickness. Our group have on-going studies using a new tool to investigate tendon structure, ultrasound tissue characterisation (UTC), to try to properly evaluate the tendon effects of this procedure. The potentials in the soft tissues on the ventral side of the Achilles are in focus for intensive research.

References Alfredson H. Br J Sports Med 2011;45:407–410

Lind et al. KSSTA 2006;14:1327–1332

Willberg et al. KSSTA 2014 [in press]