Achilles Tendinosis Study; Comparison of Radiofrequency to Surgical MicroDebridement

Typically, Achilles pain results from overuse of the calf muscles (e.g., running, jumping) or abnormal biomechanical stress on the foot and ankle.(1). Overuse can injure the fibrous tissue that connects the heel to the calf muscles. Treating an injured Achilles tendon is crucial to avoid exacerbating the injury further, which may lead to partial or full rupture of the tendon.

Tendinosis, sometimes complicated by partial rupture, appears to be the major lesion in chronic Achilles tendinopathy; the paratenon is rarely involved. Important features are a lack of inflammatory cells and a poor intrinsic ability to heal.

Several million Americans receive treatment for tendinosis each year, with more than 200,000 patients treated each year for Achilles tendonitis and tendinosis alone.(5) Conservative treatment options for Achilles pain include rest, stretching, strengthening, ice and/or physical therapy. In general, non-surgical treatment of Achilles tendonitis and tendinosis is believed to be unsuccessful, so that surgical treatment is required in about 25% of patients; however, results of traditional surgical treatments have been reported to deteriorate with time. (3).

The purpose of this study is to evaluate longitudinal improvement of AOFAS Ankle-Hindfoot Scale scores in patients with symptomatic Achilles tendinosis treated using radiofrequency-based plasma microtenotomy compared to standard surgical debridement.

Inclusion criteria

• Subject is at least 18 years of age
• Subject presents with pain associated with the Achilles tendon graded as >5 on a 0 to 10- point scale
• Subject's history and physical examination pinpoints anatomic origin of Achilles pain as associated with degeneration of the Achilles (non-insertional - proximal to retrocalcaneal bursa)
• Magnetic resonance imaging findings consistent with tendinosis
• Subject (or guardian) must sign IRB approved informed consent form
• Subject is willing and able to complete required follow-up

Exclusion criteria

• Use of NSAID's (e.g., ibuprofen, naproxen) within 2 weeks prior to treatment by this study
• Previous Achilles surgery on pathology to be treated by this study
• Heel pain associated with plantar fasciosis
• Multiple anatomic origins of pain in foot to be treated by study
• History or documentation showing Type I and Type II Diabetes Mellitus
• Physical findings and documentation of coagulopathy, infection, tumor or other systemic disease(s)
• History or documentation showing peripheral vascular disease or autoimmune disease
• Subject is currently participating in another drug/device study related to the degenerated Achilles
• Pregnant or pregnant suspected subjects prior to treatment
• History of Extracorporeal Shock Wave Treatment (ESWT) on foot to be treated by study
• Subject is incapable of understanding or responding to the study questionnaires