Most cases of patellar or Achilles tendonitis improve with exercise therapy that strengthens the muscles above and below the affected tendon. In addition, we occasionally use treatments such as GTN patches, shockwave, and tendonitis injections for some complex cases. Yet, even with the best rehabilitation and other treatments, some patients fail to return to the sport. In such cases, we try surgery or a unique injection called ‘tendon scraping’. 

What are the results of Achilles or Patellar tendon surgery?

A recent study in the British Journal of Sports Medicine compared surgery to other treatments. Firstly, the study found that surgery was equal to exercise in tennis elbow, shoulder tendonitis, and Achilles tendonitis. Furthermore, surgery risks are much higher than those of other treatments, such as shockwave or injections. In conclusion, the authors suggest that surgery should only be considered in cases that fail to settle after 12 months of conservative therapy.

In addition, traditional surgery for patellar tendonitis involving cutting the diseased tendon has poor outcomes. For example, one randomised trial for surgery in patellar tendinitis found that the success rate of this type of surgery is 50%, equal to that of physiotherapy. Also, our experience suggests that those patients who fail traditional surgery have a poor outlook.

Recently, a new type of surgery has proven effective for treating patellar tendinitis. A study co-authored by Dr. Masci demonstrated that a type of surgery known as Patellar tendon scraping reduces pain and facilitates a faster return to sports in athletes with patellar tendonitis. Furthermore, tendon scraping is safer as it does not involve opening or harming the affected tendon.

How does tendon scraping work for Achilles or Patellar tendonitis?

We suspect that tendon scraping works by removing abnormal nerves that lie on the surface of the tendon. These nerves follow blood vessels, both of which can be visualised on ultrasound. Using ultrasound, we find the precise location of these blood vessels and nerves. Removing these nerves reduces pain and facilitates a faster return to sports. We believe scraping is preferable to traditional surgery, as it avoids direct harm to the tendon.

Generally, we can detect these nerves by following the abnormal blood vessels in tendinosis. We see these abnormal blood vessels on a standard ultrasound below.

jumpers knee on ultrasound

Can we perform this tendon scraping similarly to an injection?

Yes. We believe that scraping can also be performed similarly to an injection. Firstly, the tendon can be scraped without sutures or general anaesthesia using a specialised needle with a blade and ultrasound. We perform needle scrapings on Achilles and Patellar tendons that fail other treatments. Needle scraping is considered safer than surgical scraping; however, more studies are needed to demonstrate that needle scraping is as effective as surgery. Nevertheless, we suspect needle scrapings are a good option for some patients who want to try a safer and less invasive approach than surgical scraping.

What is the recovery after a tendon scraping procedure? 

Generally, your recovery depends on the pathology and the extent of scraping performed. However, the basic principles of post-scraping management include the following:

  • We recommend keeping your ankle or knee elevated for the remainder of the day.
  • Keep the bandages on and avoid driving until the next day.
  • Avoid submerging in water. Showering is okay, but avoid swimming or hot tubs.  
  • Apply ice every 3-4 hours and apply a compressive bandage until the pain and swelling settle. 
  • For the first week, it is recommended that you rest your ankle or knee. Reduce your step count to 50% of your typical daily step count. You can continue with upper body training. 
  • After a week, you can resume tendon loading and cross-training activities, such as cycling and swimming. Once you’ve achieved your strength goals, you can progress into running and sports-specific training. Returning to sport can take 4-6 weeks or longer, depending on your pre-procedure strength. 

What are the potential risks of a tendon scraping procedure? 

Like any tendon injection or procedure, there are risks associated with an Achilles or Patellar tendon scraping. These risks include:

  • Infection (1:10000) 
  • Tendon rupture, although the risks of complete rupture are extremely low 
  • Worsening tendon pain

These risks are reduced by using a doctor experienced in performing a tendon scraping with ultrasound. 

Below is a scraping of Achilles tendonitis using a specialised needle with a small blade. Dr. Masci performs tendon scraping under local anaesthetic in a sterile office environment. Generally, we view this procedure as a safer and more cost-effective option.

Tenex procedure for tendonitis

The Tenex procedure is a new and innovative treatment for tendonitis. It uses ultrasonic energy to remove damaged tendon tissue while preserving the healthy part. Unlike surgery, it is minimally invasive and performed with local anaesthetic. Thus, it replaces the need for more invasive and riskier surgery. It is a good option for upper and lower limb tendonitis that has not responded to other treatments. It is also used in combination with tendon scraping for certain types of tendonitis. 

Final word from Sportdoctorlondon about tendon scraping

Overall, tendon scraping is an option for Achilles and Patellar tendon cases that have failed treatments such as strength training, GTN patches, and shockwave therapy. While some cases are performed in a hospital theatre, more are now done in a treatment room with a special blade, similar to a needle used for injections.

Other related conditions: 

Dr Masci is a specialist sports doctor in London. 

He specialises in muscle, tendon and joint injuries.

Ask a question
BOOK NOW
About Dr Masci