Plantaris excision in the treatment of non-insertional Achilles tendinopathy in elite athletes

J.D. Calder, R. Freeman, N. Pollock

Background: Achilles pathology is a serious and frequently occurring problem, especially in elite athletes. Recent research has suggested a role for the plantaris tendon in non-insertional achilles tendinopathy. We report on the outcomes after excision of the plantaris tendon in elite athletes.

Aim: To assess whether or not excising the plantaris tendon improves the symptoms of Achilles tendinopathy in elite athletes.

Methods: A group of 32 elite athletes who underwent plantaris tendon excision to treat medially located pain associated with non-insertional Achilles tendinopathy were investigated. Outcomes were assessed with pre and post-operative Visual Analogue Scores (VAS) for pain and the Foot and Ankle Outcome Score (FAOS) as well as time to return to sport and satisfaction scores.

Results: At a mean follow-up of 22.4 months (12-48), 29/32 (90%) of athletes were satisfied with the results. 30/32 athletes (94%) returned to sport at a mean of 10.3 weeks (5-27). The mean VAS score improved from 5.8 to 0.8 (p< 0.01) and the mean FAOS improved in all domains (p< 0.01).

Conclusions: The plantaris tendon may be responsible for symptoms in some patients with non-insertional Achilles tendinopathy. Excision using a mini-incision technique carries a low risk of complications and may provide significant improvement in symptoms enabling an early return to elite level sports.