Follow-up on “non-surgical” Achilles treatment

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I now have details from the ARRS Annual Meeting presentation on the “non-surgical” Achilles treatment discussed yesterday. It turns out that the “debridement” procedure is indeed roughly the same as what surgeons do (in some cases) when they operate on Achilles tendons: poke, prod, and generally make the tendon angry with the hope of triggering its own healing mechanisms. The difference is that, instead of cutting open the ankle, the new procedure simply uses a needle, guided by ultrasound to the right part of the tendon. Here’s how the researchers, from Northwestern University, describe it:

The procedure was performed using a 20-gauge spinal needle that is placed into the Achilles tendon under ultrasound guidance. Approximately 50 to 60 to and fro movements are made into the abnormal tendon.

Ouch. A 20-gauge needle (as best I can make out) is just under one millimetre in diameter, so that’s considerably less invasive than being cut open. Still, it’s clear that this is only something to consider once conservative approaches (stretching, anti-inflammatories, physical therapy, immobilization) have been exhausted for at least six months.

As for the numbers, there were 17 patients with a mean age of 50. Ten of the patients reported improvement, range from “slight improvement in appearance of tendinosis” (which doesn’t sound all that earth-shattering) to complete recovery. Of the seven who didn’t improve, three subsequently had successful surgery — which suggests that the needle can’t do everything that surgery can. All in all, this seems like something that will fill a fairly narrow niche between conservative and surgical treatments — but still welcome news for those who avoid surgery as a result.