Achilles Tendinopathy

Sydney C. Karnovsky

Mark C. Drakos

Positioning

Place the patient in a prone position.
Place a nonsterile tourniquet on the operative thigh. Prep and drape the lower extremity in a sterile manner.
Exsanguinate the lower extremity and inflate the tourniquet 250 mm Hg.

Surgical Approach

Identify the Achilles, and make an incision over the tendon (Figures 12-1, 12-2, 12-3).
- Cheat medial to midline because of improved vascular supply.
  
  Figure 12-1. The patient’s area of tendinopathy is identified on the magnetic resonance imaging (arrow indicating area of tendinopathy). This is a patient with mid-substance tendinosis.
  
  Figure 12-2. The patient’s area of tendinopathy is identified on the magnetic resonance imaging (arrow indicating area of tendinopathy). This is a patient with insertional tendinosis.
  
  Figure 12-3. The site of the incision is identified and marked on the patient’s leg in a prone position.
- Base the size and location of the incision on the degree and location (either mid-substance or insertional) of tendinosis.
  
  Dissect the incised area to the level of the Achilles tendon (Figure 12-4).
  
  Figure 12-4. An incision is made over the Achilles tendon and the paratenon layer is incised.
Incise the paratenon sharply in line with its fibers.
Identify the area of tendinosis. Look for small tears, tissue integrity, and tissue quality. Determine whether any tissue looks salvageable (Figure 12-5).

Figure 12-5. The area of tendinosis is exposed.

Proceed to debride the area of tendinosis and remove the parts of the tendon that have significant degeneration within them (Figures 12-6, 12-7, 12-8, 12-9).