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Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Achilles tendinopathy is a problem that is generally difficult to treat. The pain is frequently most prominent on the medial side of the mid-portion of the tendon, where the plantaris tendon is running parallel to the Achilles tendon. The purpose of this study was to assess whether excision of the plantaris tendon would relieve symptoms.

Methods

Three patients with pain and stiffness at the mid-portion of the Achilles tendon were treated by excision of the plantaris tendon. Preoperatively, these patients experienced recognizable tenderness on palpation of the medial side of the mid-portion of the Achilles tendon with localized nodular thickening at 4–7 cm proximal to the insertion. MRI indicated Achilles tendinopathy with the involvement of the plantaris tendon.

Results

The plantaris tendon was bluntly retrieved and excised with a tendon stripper through a 4-cm incision in the proximal calf. We report a good-to-excellent outcome of this novel procedure in three patients with chronic mid-portion Achilles tendinopathy

Conclusion

The medial pain might be based on the involvement of the plantaris tendon in the process.

Level of evidence

IV.

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References

  1. Alfredson H, Zeisig E, Fahlstrom M (2009) No normalisation of the tendon structure and thickness after intratendinous surgery for chronic painful midportion Achilles tendinosis. Br J Sports Med 43:948–949

    Article  PubMed  CAS  Google Scholar 

  2. Andersson G, Danielson P, Alfredson H, Forsgren S (2007) Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 15:1272–1279

    Article  PubMed  Google Scholar 

  3. Andres KH, von DM, Schmidt RF (1985) Sensory innervation of the Achilles tendon by group III and IV afferent fibers. Anat Embryol (Berl) 172:145–156

    Article  CAS  Google Scholar 

  4. Carmont MR, Maffulli N (2007) Less invasive Achilles tendon reconstruction. BMC Musculoskelet Disord 8:100

    Article  PubMed  Google Scholar 

  5. Cummins EJ, Anson JB, Carr WB (1946) The structure of the calcaneal tendon [of Achilles] in relation to orthopedic surgery with additional observations on the plantaris muscle. Surg Gynecol Obstet 83:107–110

    PubMed  CAS  Google Scholar 

  6. Daseler EH (1943) The plantaris muscle: an anatomical study of 750 specimens. J Bone Joint Surg 25:822–827

    Google Scholar 

  7. Emerson C, Morrissey D, Perry M, Jalan R (2010) Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls—An observational study. Man Ther 15:37–42

    Article  PubMed  Google Scholar 

  8. Haims AH, Schweitzer ME, Patel RS, Hecht P, Wapner KL (2000) MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals. Skeletal Radiol 29:640–645

    Article  PubMed  CAS  Google Scholar 

  9. Harvey FJ, Chu G, Harvey PM (1983) Surgical availability of the plantaris tendon. J Hand Surg Am 8:243–247

    Google Scholar 

  10. Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525

    PubMed  CAS  Google Scholar 

  11. Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, Taunton JE (2003) Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med 37:149–153

    Article  PubMed  CAS  Google Scholar 

  12. Kvist H, Kvist M (1980) The operative treatment of chronic calcaneal paratenonitis. J Bone Joint Surg Br 62:353–357

    PubMed  CAS  Google Scholar 

  13. Lian O, Dahl J, Ackermann PW, Frihagen F, Engebretsen L, Bahr R (2006) Pronociceptive and antinociceptive neuromediators in patellar tendinopathy. Am J Sports Med 34:1801–1808

    Article  PubMed  Google Scholar 

  14. Longo UG, Ramamurthy C, Denaro V, Maffulli N (2008) Minimally invasive stripping for chronic Achilles tendinopathy. Disabil Rehabil 30:1709–1713

    Article  PubMed  Google Scholar 

  15. Maffulli N, Binfield PM, Moore D, King JB (1999) Surgical decompression of chronic central core lesions of the Achilles tendon. Am J Sports Med 27:747–752

    PubMed  CAS  Google Scholar 

  16. Maffulli N, Sharma P, Luscombe KL (2004) Achilles tendinopathy: aetiology and management. J R Soc Med 97:472–476

    Article  PubMed  Google Scholar 

  17. Maffulli N, Testa V, Capasso G, Bifulco G, Binfield PM (1997) Results of percutaneous longitudinal tenotomy for Achilles tendinopathy in middle- and long-distance runners. Am J Sports Med 25:835–840

    Article  PubMed  CAS  Google Scholar 

  18. Maquirriain J, Ayerza M, Costa-Paz M, Muscolo DL (2002) Endoscopic surgery in chronic achilles tendinopathies: A preliminary report. Arthroscopy 18:298–303

    Article  PubMed  Google Scholar 

  19. Nelen G, Martens M, Burssens A (1989) Surgical treatment of chronic Achilles tendinitis. Am J Sports Med 17:754–759

    Article  PubMed  CAS  Google Scholar 

  20. Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45–56

    Article  PubMed  CAS  Google Scholar 

  21. Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341

    Article  PubMed  CAS  Google Scholar 

  22. Rolf C, Movin T (1997) Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int 18:565–569

    PubMed  CAS  Google Scholar 

  23. Sandmeier R, Renstrom PA (1997) Diagnosis and treatment of chronic tendon disorders in sports. Scand J Med Sci Sports 7:96–106

    Article  PubMed  CAS  Google Scholar 

  24. Schubert TE, Weidler C, Lerch K, Hofstadter F, Straub RH (2005) Achilles tendinosis is associated with sprouting of substance P positive nerve fibres. Ann Rheum Dis 64:1083–1086

    Article  PubMed  CAS  Google Scholar 

  25. Segesser B, Goesele A, Renggli P (1995) The Achilles tendon in sports. Orthopade 24:252–267

    PubMed  CAS  Google Scholar 

  26. Smith RK, Birch HL, Goodman S, Heinegard D, Goodship AE (2002) The influence of ageing and exercise on tendon growth and degeneration–hypotheses for the initiation and prevention of strain-induced tendinopathies. Comp Biochem Physiol A Mol Integr Physiol 133:1039–1050

    Article  PubMed  CAS  Google Scholar 

  27. Steenstra F, van Dijk CN (2006) Achilles tendoscopy. Foot Ankle Clin 11:429–438

    Article  PubMed  Google Scholar 

  28. Stillwell DL Jr (1957) The innervation of tendons and aponeuroses. Am J Anat 100:289–317

    Article  Google Scholar 

  29. Tan SC, Chan O (2008) Achilles and patellar tendinopathy: current understanding of pathophysiology and management. Disabil Rehabil 30:1608–1615

    Article  PubMed  Google Scholar 

  30. Tuite DJ, Renstrom PA, O’Brien M (1997) The aging tendon. Scand J Med Sci Sports 7:72–77

    Article  PubMed  CAS  Google Scholar 

  31. van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA, Tol JL, Weinans H (2010) Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med 44:1153–1159

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Academic Medical Center, PO Box 22700, 1100, DE Amsterdam, The Netherlands

    Maayke N. van Sterkenburg, Gino M. M. J. Kerkhoffs & C. Niek van Dijk

Authors
  1. Maayke N. van Sterkenburg
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  2. Gino M. M. J. Kerkhoffs
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  3. C. Niek van Dijk
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Correspondence to Maayke N. van Sterkenburg.

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van Sterkenburg, M.N., Kerkhoffs, G.M.M.J. & van Dijk, C.N. Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 19, 1362–1366 (2011). https://doi.org/10.1007/s00167-011-1514-0

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  • DOI: https://doi.org/10.1007/s00167-011-1514-0

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