Use of Ultrasound-Guided Tenotomy and Debridement in Chronic Achilles Tendinopathy: A Prospective Study

Achilles tendinopathy (AT) is a prevalent musculoskeletal pain condition characterized by activity-related heel pain, elevated pain-related psychological factors, and decreased function. Although exercise is recommended as a front-line treatment for AT, up to 60% of individuals experience persistent pain and could benefit from the availability of second-line treatment options. Ultrasound-guided tenotomy and debridement (USGTD) is a minimally invasive treatment for individuals who do not respond to first-line treatments, yet the impact on pain, psychological factors, and function remains insufficiently studied. This prospective cohort study aimed to investigate the effect of USGTD on clinical outcomes in individuals with chronic AT who had tried first-line treatments for at least 3 months. Forty-two patients (71% Female, Age: 26 – 72 years, BMI: mean: 37.6(SD: 8.9)) were enrolled. Linear mixed models were used to assess the effect of time on pain (NRS: 0-10), kinesiophobia (TSK-17), pain catastrophizing (PCS), and function (FAAM-ADL). At baseline, patients had moderate pain (NRS: 6.3(95%CI: 5.7, 6.9), elevated kinesiophobia (42.0(40.7, 44.6), pain catastrophizing (14.7(12.4, 16.9), and decreased function (FAAM: 53.5(48.2 to 58.1)). By 12-weeks, patients reported decreased pain (NRS: mean improvement: -3.0(95%CI: -2.3 to -3.8), kinesiophobia (TSK-17: -8.1(-6.6 to -10.3), pain catastrophizing (PCS: -10(-5.8 to -10.8)), and increased function (FAAM: 23.9(18.0 to 29.7)). These improvements were sustained at 1-year follow-up (NRS: -3.5(-2.7 to -4.2), TSK-17: -9.2(-7.1 to -11.1), PCS: -9.5(-6.8 to -12.1), FAAM: 26.2(20.0 to 32.3). Our findings suggest that USGTD yields clinically meaningful, enduring improvements in clinical outcomes. Further evaluation through randomized trials is essential.