Introduction
Materials and methods
Search strategy
Inclusion criteria
Data extraction
Complications | |
---|---|
Major | Minor |
AT rupture | Discomfort |
Any reoperation | Superficial infections |
Deep venous thrombosis | Minor wound problems |
Reflex dystrophy | Scar tenderness/hypertrophy |
Persisting neuralgia | Mild form of paraesthesia |
Deep infections/major wound problems | Prolonged hospitalisation |
Methodological quality
Data presentation and statistical analysis
Results
Study |
N patients (N tendons) | Surgical technique | Coleman | D&B |
---|---|---|---|---|
Open debridement | ||||
Benazzo et al. [4] | A. 20 (20) | A. Open surgery: multiple longitudinal tenotomies and excision degenerations | 54 | 22 |
B. 32 (32) | B. Open surgery: excision degeneration + soleus fibres transfer | |||
Johnston et al. [11] | A. 10 (10) | A. Open surgery: excision inflamed paratenon and decompression AT | 29 | 7 |
B. 7 (7) | B. Open surgery: excision inflamed paratenon, decompression AT + debridement degenerations | |||
Kvist and Kvist [13] | 182 (201) | Open surgery: removal adhesions between paratenon, crural fascia and skin + excision thickened paratenon | 27 | 14 |
Lohrer and Nauck [15] | A. 11 (15) | A. Open surgery: release AT + transachillear scarification | 60 | 23 |
B. 23 (24)
| B. Open surgery: release AT + excision intratendinous lesions + transachillear scarification | |||
Maffulli et al. [18] | 10 (10) | Open surgery: excision paratenon, multiple longitudinal tenotomies and excision of degenerations | 39 | 10 |
Maffulli et al. [21] | 86 (86) | Open surgery: excision paratenon, multiple longitudinal tenotomies + excision degenerations | 69 | 14 |
Nelen et al. [26] | A. (93) | A. Open surgery: release AT (not ventrally) + excision inflamed paratenon | 42 | 16 |
B. (26) | B. Open surgery: debridement tendinosis | |||
C. (24) | C. Open surgery: debridement tendinosis (reinforcement with turned-down tendon flap) | |||
Ohberg et al. [27] | 24 (24) | Open surgery: excision hypertrophic paratenon and debridement of degenerations through a longitudinal incision | 52 | 15 |
Paavola et al. [29] | A. 171 (171) | A. Open surgery: excision adhesions between crural fascia and paratenon | 24 | 9 |
B. 50 (50) | B. Open surgery: debridement intratendinous lesions | |||
Paavola et al. [28] | A. 16 (16) | A. Open surgery: excision adhesions between crural fascia and paratenon | 56 | 14 |
B. 26 (26) | B. Open surgery: excision adhesions between crural fascia and paratenon + debridement intratendinous lesions | |||
Sarimo and Orava [31] | 24 (24) | Open surgery: fascial adhesiolysis and radiofrequency microtenotomy | 36 | 20 |
Minimally invasive tendon stripping/tenotomies | ||||
Alfredson et al. [2] | 10 (10) | Minimally invasive: US–CD-guided release ventral AT | 48 | 17 |
Alfredson [1]a
| A. 15 (18) | A. Minimally invasive: US–CD-guided release ventral AT | 41 | 17 |
B. 16 (19) | B. Minimally invasive: US–CD-guided release ventral AT by use of a needle | |||
Alfredson [1]a
| 72 (88) | Minimally invasive: US–CD-guided release ventral AT | 30 | 14 |
Alfredson et al. [3] | 13 (13) | Minimally invasive: US–CD-guided release ventral AT | 46 | 17 |
Calder et al. [6] | 32 (34) | Minimally invasive: Release AT and excision plantaris tendon | 59 | 21 |
Maffulli et al. [20] | 39 (39) | Minimally invasive: multiple percutaneous longitudinal tenotomies | 59 | 20 |
Naidu et al. [24] | 26 (29) | Minimally invasive: circumferential AT release with a tracheal hook + peritendinous infusion of corticosteroids | 40 | 17 |
Testa et al. [36] | 63 (63) | Minimally invasive: multiple US-guided percutaneous longitudinal tenotomies | 65 | 20 |
Endoscopic procedures | ||||
Maquirriain [22] | 24 (27) | Endoscopic: debridement paratenon + two longitudinal tenotomies | 52 | 13 |
Pearce et al. [30] | 11 (11) | Endoscopic: debridement paratenon + release of plantaris tendon | 60 | 13 |
Steenstra and van Dijk [33] | 16 (16) | Endoscopic: debridement paratenon + release of plantaris tendon | 26 | 11 |
Open surgery: gastrocnemius lengthening | ||||
Duthon et al. [10] | 13 (15) | Open surgery: gastrocnemius lengthening | 65 | 15 |
Open surgery: autologous tendon transfer | ||||
Martin et al. [23] | 44 (44) | Open surgery: excision AT + FHL transfer | 54 | 21 |
Population characteristics
Surgical techniques
Open surgery
Study | Postoperative satisfaction | Complications | ||||
---|---|---|---|---|---|---|
Satisfied | Unsatisfied | Major | Minor | Total | Reoperations | |
Open debridement | ||||||
Benazzo et al. [4] | A. 1/20 (5 %) | A. 2/20 (10 %) | A. 3/20 (15 %) | A. 1/20 (5 %) | ||
B. 1/32 (3.1 %) | B. 3/32 (9.4 %) | B. 4/32 (12.5 %) | B. 1/32 (3.1 %) | |||
Johnston et al. [11] | 0/17 (0 %) | 0/17 (0 %) | 0/17 (0 %) | |||
Kvist and Kvist [13] | 20/201 (10.0 %) | 2/201 (1.0 %) | 22/201 (10.9 %) | 20/201 (10.0 %) | ||
Lohrer and Nauck [15] | ||||||
Maffulli et al. [18] | 6/14 (42.9 %) | 6/14 (42.9 %) | 12/14 (85.7 %) | 6/14 (42.9 %) | ||
Maffulli et al. [21] | 8/86 (9.3 %) | 23/86 (26.7 %) | 31/86 (36.0 %) | 8/86 (9.3 %) | ||
Nelen et al. [26] | A+B+C. 12/143 (8.4 %) | A+B+C. 2/143 (1.4 %) | A+B+C. 14/143 (9.8 %) | A. 4/93 (4.3 %) | ||
B. 1/26 (3.8 %) | ||||||
C. 0/24 (0 %) | ||||||
Ohberg et al. [27] | 0/24 (0 %) | 2/24 (8.3 %) | 2/24 (8.3 %) | 0/24 (0 %) | ||
Paavola et al. [29] | A. 9/171 (5.3 %) | A.18/171 (10.5 %) | A. 27/171 (15.8 %) | A. 9/171 (5.3 %) | ||
B. 0/50 (0 %) | B. 1/50 (2 %) | B. 1/50 (2 %) | B. 0/50 (0 %) | |||
Paavola et al. [28] | A+B. 2/42 (4.8 %) | A+B. 6/42 (14.3 %) | A+B. 8/42 (19.1 %) | A+B. 2/42 (4.8 %) | ||
Sarimo and Orava [31] | 1/24 (4.2 %) | 1/24 (4.2 %) | 2/24 (8.3 %) | |||
Totals | 60/824 (7.3 %) | 66/824 (8.0 %) | 126/824 (15.3 %) | |||
Minimally invasive tendon stripping/tenotomies | ||||||
Alfredson et al. [2] | 10/10 (100 %) | 1/10 (10 %) | 0/10 (0 %) | 1/10 (10 %) | ||
Alfredson [1]a
| A. 15/18 (83.3 %)b
| A. 3/18 (16.7 %)b
| A+B. 3/37 (8.1 %) | A+B. 0/37 (0 %) | A+B. 3/37 (8.1 %) | |
B. 15/19 (78.9 %)b
| B. 4/19 (21.1 %)b
| |||||
Alfredson [1]a
| 81/88 (92.0 %)b
| 7/88 (8.0 %)b
| ||||
Alfredson et al. [3] | 11/13 (84.6 %) | 2/13 (15.4 %) | ||||
Calder et al. [6] | 22/32 (69 %)c
| 10/32 (31 %)c
| 0/34 (0 %) | 1/34 (2.9 %) | 1/34 (2.9 %) | |
Maffulli et al. [20] | ||||||
Naidu et al. [24] | 24/26 (92 %)c
| 2/26 (7.7 %)c
| 1/29 (3.4 %) | 2/29 (6.9 %) | 3/29 (10.3 %) | 1/29 (3.4 %) |
Testa et al. [36] | 9/75 (12 %) | 14/75 (18.6 %) | 23/75 (30.6 %) | 9/75 (12 %) | ||
Totals | 14/185 (7.6 %) | 17/185(9.2 %) | 31/185 (16.8 %) | |||
Endoscopic procedures | ||||||
Maquirriain [22] | 2/27 (7.4 %) | 0/27 (0 %) | 2/27 (7.4 %) | |||
Pearce et al. [30] | 8/11 (73 %) | 3/11 (27 %) | 0/11 (0 %) | 0/11 (0 %) | 0/11 (0 %) | 0/11 (0 %) |
Steenstra and van Dijk [33] | 0/20 (0 %) | 0/20 (0 %) | 0/20 (0 %) | |||
Totals | 2/58 (3.4 %) | 0/58 (0 %) | 2/58 (3.4 %) | |||
Open surgery: gastrocnemius lengthening | ||||||
Duthon et al. [10] | 12/13 (92.3 %)c
| 1/13 (7.7 %)c
| 0/15 (0 %) | 0/15 (0 %) | 0/15 (0 %) | |
Open surgery: autologous tendon transfer | ||||||
Martin et al. [23] | 37/44 (86 %) | 6/44 (13.8 %) | 1/44 (2.3 %) | 4/44 (9.1 %) | 5/44 (11.4 %) |
Study | Success rate | |
---|---|---|
Successful | Unsuccessful | |
Open debridement | ||
Benazzo et al. [4] | ||
Johnston et al. [11] | ||
Kvist and Kvist [13]b
| 194/201 (96.5 %) | 7/201 (3.5 %) |
Lohrer and Nauck [15]b
| 15/15 (100 %) | |
23/24 (95.8 %) | 1 (4.2 %) | |
Maffulli et al. [18] | ||
Maffulli et al. [21] | ||
Nelen et al. [26]b
| A. 82/93 (88.2 %) | A. 11/93 (11.8 %) |
B. 19/26 (73.1 %) | B. 7/26 (26.9 %) | |
C. 21/24 (87.5 %) | C. 3/24 (12.5 %) | |
Ohberg et al. [27] | 22/24 (91.7 %) | 2/24 (8.3 %) |
Paavola et al. [29] | ||
Paavola et al. [28] | A. 16/16 (100 %) | |
B. 19/26 (73.1 %) | B. 7/26 (26.9 %) | |
Sarimo and Orava [31] | 24/24 (100 %) | |
Minimally invasive tendon stripping/tenotomies | ||
Alfredson et al. [2] | 10/10 (100 %) | |
Alfredson [1]a,b
| A. 15/18 (83.3 %) | A. 3/18 (16.7 %) |
B. 15/19 (78.9 %) | B. 4/19 (21.1 %) | |
Alfredson [1]a,b
| 81/88 (92.0 %) | 7/88 (8.0 %) |
Alfredson et al. [3] | 11/13 (84.6 %) | 2/13 (15.4 %) |
Calder et al. [6]c
| 22/32 (69 %) | 10/32 (31 %) |
Maffulli et al. [20] | 30/39 (76.9 %) | 9/39 (23.1 %) |
Naidu et al. [24]c
| 24/26 (92 %) | 2/26 (7.7 %) |
Testa et al. [36] | 47/63 (74.6 %) | 16/63 (25.4 %) |
Endoscopic procedures | ||
Maquirriain [22]c
| 24/24 (100 %) | |
Pearce et al. [30] | 8/11 (73 %) | 3/11 (27 %) |
Steenstra and van Dijk [33] | ||
Open surgery: gastrocnemius lengthening | ||
Duthon et al. [10]c
| 12/13 (92.3 %) | 1/13 (7.7 %) |
Open surgery: autologous tendon transfer | ||
Martin et al. [23] | 37/44 (86 %) | 6/44 (13.8 %) |