Arthroscopic debridement combined with microfracture for chronic enthesiopathy of achilles tendon

Abstract

Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon. Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016. There were 11 males and 4 females, with an average age of 55.5±8.9 years. Five were in left side, and 10 in right side. All the patients failed to recover after conservative treatments for 18 months to 10 years. Pathological tissue was eliminated by blade. Then microfracture was made. Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon. These holes were made far enough (3-4 mm) apart so they do not break into each other. Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached. The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores. Results Average operation time and length of stay were 30.6±15.4 min and 6.2±2.8 d, respectively. Postoperative incisions were I stage healing for all patients. There were no perioperative and postoperative complications related to the procedure, such as rupture of achilles tendon, blood vessel and nerve injury. No infection and recurrence was found in all cases. All patients were followed up for an average time of 13.5 months. No rupture of achilles tendon or relapsing symptom was found. Average VAS scores before surgery, 6 month after surgery and at the lattest follow-up were 7.3±1.6, 2.4±1.3, and 2.3±1.3, respectively. Average AOFAS Ankle-Hindfoot scores were 38.5±7.8, 92.9±6.9, and 91.6±7.1, respectively. Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery. There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores. At the latest follow-up, all patients were satisfied with the degree of painful relief. According to AOFAS Ankle-Hindfoot scores, overall excellent and good rate was 93.3% (excellent in 10 cases, good in 4 cases, and fair in 1 case). Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good. This technique is easy and safe to perform. Key words: Arthroscopy; Arthroplasty, subchondral; Achilles tendon; Heel pain