Most patellar or Achilles tendonitis improves with exercise therapy to strengthen 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 rehab and other treatments, some patients fail to get back to the sport. So we try surgery or a unique injection called ‘tendon scraping’ in these cases.
What are the results of Achilles or Patellar tendon surgery?
A recent British Journal of Sports Medicine study 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 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 tendonitis found that the success of this type of surgery is 50% – equal to 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 Patellar tendonitis. A study co-authored by Dr. Masci showed that a type of surgery known as Patellar tendon scraping reduces pain and allows a faster return to sport 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 are seen on ultrasound. Using ultrasound, we find the precise location of these blood vessels and nerves. Removing these nerves reduces pain and allows for a faster return to sport. We think scraping is better than traditional surgery as it avoids harming the tendon directly.
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.
Can we perform this tendon scraping like an injection?
Yes. We think that scraping can also be performed like an injection. Firstly, scraping of the tendon can be done without the need for sutures or general anesthetic by using a specialized needle with a blade and ultrasound. We perform needle scrapings on Achilles and Patellar tendons that fail other treatments. Needle scraping is safer than surgical scraping, but we need more studies to show that needle scrapings work and 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.
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 see this procedure as a safer and cheaper option.
Final word from Sportdoctorlondon about tendon scraping
Overall, tendon scraping is an option for Achilles and Patellar tendon cases that fail treatments such as strength training, GTN patches, and shockwave. While some cases are done in theatre, more are now done with a special blade, like an injection.
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