New surgical technique offers faster recovery for stubborn Achilles tendon injuries
Surgeons have successfully treated 53 cases of chronic Achilles tendon pain using a minimally invasive, ultrasound-guided procedure that lets patients walk immediately after surgery. The approach could reduce recovery time and healthcare costs for the thousands of people annually disabled by this injury, while opening new revenue opportunities for orthopedic surgery centers adopting the technique.
Originaltitel: Ultrasound- and Colour Doppler-Guided WALANT Surgery for Insertional Achilles Tendinopathy: A Prospective Case Series on 53 Consecutive Patients
<p>Background: Treatment of chronic painful insertional Achilles tendinopathy is known to be challenging. If non-surgical treatment does not give sufficient relief of symptoms, surgery may be indicated. Treatment with ultrasound (US)- and colour Doppler (CD)-guided wide-awake-local-anaesthetic-no-tourniquet (WALANT) surgery for insertional Achilles tendinopathy is a new approach with promising clinical results. This study aimed to evaluate clinical results of this new approach on patients suffering from insertional Achilles tendinopathy. Methods: Forty-eight consecutive patients with 53 symptomatic tendons (33 men with 34 tendons, mean age 49.3 +/- 12.0 years; 14 women with 18 tendons, mean age 55.0 +/- 7.4 years) and a duration of more than 12 months with painful insertional Achilles tendinopathy (including tendon, bursae, bone, and plantaris pathology) were included. US- and CD-guided WALANT surgery with removal of pathological bursae, bone, and tendons was used. Immediate weight-bearing loading was allowed, followed by a structured rehabilitation protocol for the first 12 weeks after surgery. VISA-A scores before and after surgery and a questionnaire that evaluated subjective satisfaction with the treatment and current activity level were used. Results: In total, 42/48 patients with 46/53 tendons participated in a 3-year follow-up (mean 34 +/- 9 months) by an independent examiner; 39/42 patients with 43/46 tendons were satisfied (n = 37) with the treatment. The mean VISA-A score increased significantly from 41.9 +/- 18.2 pre-operatively to 87.7 +/- 18.2 post-operatively (p &lt; 0.001). There were three surgical complications, two superficial wound infections, and one minor wound rupture. Conclusions: Patients who suffered from chronic painful insertional Achilles tendinopathy treated with US- and CD-guided WALANT surgery followed by immediate weight-bearing showed high patient subjective satisfaction rates and better functional scores at the 3-year follow-up with a low complication rate. This novel treatment approach warrants more study, including randomised trials comparing it against traditional surgical procedures according to Nunley and Keck and Kelly.</p>