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Tendinopathy affects tendons by causing pain, swelling, and poor physical performance. It isn't simply a problem of inflammation as in tendinitis. Rather, tendinopathy causes degeneratation in the cellular make-up of the tissue. Tendinopathy of the Achilles tendon--the tendon that joins the calf muscles to the heel bone--often comes from intense athletic training and overuse. People with this condition often get better without surgery. But about 25 percent of people with chronic problems need surgery.

Achilles tendon surgery using large incisions (open surgery) causes wound healing problems in 10 to 15 percent of patients. These authors wanted to explore the use of a less invasive surgical technique. They used an endoscope, an instrument with a tiny camera on the end of it. This lets doctors see inside the body without making big incisions in the skin. This instrument has been used in many joint surgeries. However, only a few studies have examined endoscopic surgery for tendon problems.

Seven patients with chronic Achilles problems had this type of surgery. The patients were recreational athletes who didn't improve after a few months of physical therapy. Their symptoms included pain with activity, morning stiffness, tenderness, and poor sports performance. In some cases, they also had changed walking patterns and decreased strength.

Doctors used an endoscope to "release" the inflamed tissue and shave off any damaged tissue. Three to six days after surgery, most patients were allowed to put weight on the affected leg. Patients returned to sports gradually. Three to six weeks after surgery, they started jogging.

Before and after surgery, patients' symptoms were rated on a scale of zero to 100, with zero being the worst symptoms. Before surgery, the average score was 39. About a year after surgery, all but one of the patients scored in the 90 to 100 range. (The patient with the lowest score had stopped rehabilitation because of an unrelated health problem.) MRI showed no degenerative changes in the tendon after surgery.

There were no major complications from surgery. Though the number of patients studied was small, the authors think this procedure may have several benefits over open surgery for the treatment of chronic Achilles tendinopathies. The endoscopic procedure is faster and easier. It reduces symptoms and get patients back to their activities without the added complications of wound healing. Still, more studies are needed to confirm these results.

Javier Maquirriain, MD, et al. Endoscopic Surgery in Chronic Achilles Tendinopathies: A Preliminary Report. In Arthroscopy. March 2002. Vol. 18. No. 3. Pp. 298-303.

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