Disclosures: Richa Lamba, MD: Nothing to disclose

Case Description: Physical exam did not elicit pain and no deficits were noted with range of motion or strength testing. Diagnostic ultrasound showed severe mid-substance Achilles chronic tendinosis with marked hypertrophy. The affected tendon had an increase in max diameter (MD) and cross-sectional area (CSA) by 9.33 mm and 9.3 mm², respectively. Additionally, chronic increased Doppler flow was noted, consistent with neovessel formation and Kager’s fat pad anchoring. After initiation of physical therapy (PT), including eccentrics, and prescription for alternative footwear with arch/heel support, ultrasound guided Achilles tendon scraping with neovessel ablation and peritendinous triamcinolone injection was performed.

Setting: Ambulatory clinic

Patient: 54-year-old female with chronic pain along the right Achilles tendon.

Assessment/Results: Patient returned at 3 months, having completed a course of PT, and reported 85-90% relief in pain and ability to ambulate greater distances. Repeat ultrasound showed reduction in MD and CSA by 2.2 mm and 5.2 mm², respectively. Near total resolution of neovessel formation was noted with decreased flow signal intratendinously, peritendinously, in cross-bridging into Kager’s fat pad and within Kager’s fat pad. Intrasubstance tearing appeared slightly improved secondary to reduction in intratendinous vasculature/swelling. At 6 months, patient reported 90% pain relief for the first 4 months and 50% since, accompanied with pain with prolonged walking and gradual increase in ankle swelling. Ultrasound at 6 months showed no interval change from 3-month follow up.

Discussion: Chronic Achilles tendinosis is associated with abnormal healing mechanisms including neovessel formation and Kager’s fat pad anchoring which can cause further weakening of the tendon and increased susceptibility to damage. Tendon scraping can be an effective method of treating this condition as evidenced by the clinical and ultrasound results at three and six months in this case.

Conclusion: This case supports ultrasound guided tendon scraping as an appropriate treatment of chronic Achilles tendinosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-achilles-tendinosis-treated-with-ultrasound-guided-scraping-and-neovessel-ablation-a-case-report/