Quick answer
For selected refractory mid-substance Achilles tendinopathy, surgery may involve removal of visibly diseased tendon, release of adhesions or paratenon, and treatment of associated pathology. The operation should be tailored to the extent and location of disease.
Article
What surgery is trying to achieve
The goal is to address a defined pain-generating or mechanically relevant pathology while preserving as much functional tendon as possible.
Procedure selection
Options described in the literature include open or minimally invasive debridement, paratenon procedures and other techniques. More extensive degeneration may require reconstruction rather than simple debridement.
Why imaging and examination matter
The amount of abnormal signal on MRI does not dictate the operation by itself. Surgical planning should integrate focal tenderness, function, ultrasound/MRI findings and the patient’s goals.
Key points
- Minimally invasive does not automatically mean appropriate for every tendon.
- The extent of tendon disease influences whether debridement alone is sufficient.
- Postoperative loading and calf rehabilitation remain essential.
Frequently Asked Questions
Is all abnormal tendon removed?
Not necessarily. The aim is to treat clinically relevant diseased tissue while preserving functional tendon where possible.
Will surgery immediately restore strength?
No. Strength and load tolerance must be rebuilt during postoperative rehabilitation.