Effects of Ultrasound-Guided Tenotomy and Debridement on Pain, Function, and Psychological Factors for Achilles Tendinopathy: A Prospective Cohort Study.

Abstract

Ultrasound-guided tenotomy and debridement is a minimally invasive treatment with a low risk of complications for individuals with chronic Achilles tendinopathy. Yet the benefits of this procedure on pain, function, and pain-related psychological factors, as well as predictors of treatment success, remain understudied. A total of 56 individuals with chronic Achilles tendinopathy (mean (SD): age = 55.9 (11) years, BMI = 34.8 (8.2) kg/m², women = 68%) underwent baseline ultrasonography, followed by ultrasound-guided tenotomy and debridement, and rehabilitation. Participants reported pain (0-10), function (Foot and Ankle Ability Measure-ADL), kinesiophobia (Tampa Scale of Kinesiophobia-17), and pain catastrophizing (Pain Catastrophizing Scale) at baseline and for a year following the procedure. Baseline pain was 6.1 (2.2), kinesiophobia was 40.8 (7.1), pain catastrophizing was 13.7 (10.2), and function was 55.9 (17.3). By 6 weeks, there were decreases in pain (mean change (95% CI): -1.9 (-1.1 to -2.6), function: 14.4 (9.3-19.5), kinesiophobia: -5 (-3.2 to -6.9), and pain catastrophizing: -7 (-4.9 to -9.1)). Patient-reported outcomes were similar at 52 weeks (pain: -2.99 (-2.2 to -3.8), function: 25.1 (19.6-30.7), kinesiophobia: -7.5 (-6.1 to -11.4), catastrophizing: -8.5 (-6.1 to -10.8)) following the procedure. Haglund deformity (β: -13.1 (-0.6 to -25.5)) and intratendinous calcifications (β: -14.7 (-1.4 to -28.1)) were associated with smaller improvements in function. No procedure-related complications were reported. Clinical significance: Ultrasound-guided tenotomy and debridement for chronic Achilles tendinopathy may provide positive outcomes for pain, function, and pain-related psychological factors at 6-week and 1-year follow-up. Haglund deformity and tendon calcifications were associated with smaller improvements in function.