Mattiussi Gabriele, Moreno Carlos
Medical Services, Udinese Football Club, Udine, Italy.
J Am Podiatr Med Assoc. 2018 Sep 1;108(5):437-441. doi: 10.7547/17-078.
Plantaris tendon disorders are a well-known source of midportion Achilles tendinopathy. Plantaris tendon thickening and fibrous tissue formation between the tendons are the histologic abnormalities that are typically observed. Surgical approaches (scraping of the Achilles medial and ventral paratendinous tissues and excision of the plantaris tendon) have already shown good clinical outcomes; despite this, the cost-benefit ratio of these interventions may be unfavorable, and their accessibility is limited. Percutaneous needle electrolysis is a minimally invasive ablative technique increasingly being considered for the treatment of tendinopathies and associated conditions. Herein we introduce a novel procedure to treat plantaris tendon-related midportion Achilles tendinopathy. The procedure starts with the ultrasound-guided insertion of an uncoated needle (diameter, 0.30-0.40 mm; length, 30 mm) between the plantaris and Achilles tendons. Subsequently, galvanic current (intensity, 2 mA) is locally transferred, which induces instant nonthermal electrochemical ablation of the intertendinous tissues in close proximity to the needle, finally debriding the plantaris tendon. To further promote its release, the second part of the procedure involves partial tenotomy of the lateral peripheral aspects of the plantaris tendon. Usually, the session does not exceed 30 min. Percutaneous needle electrolysis may be considered as a valid alternative to surgery. The outpatient procedure presented herein is, in fact, safe and quick to perform. In addition, long suspension of working or sporting activities after treatment is not required. Future investigations are needed to ascertain the short- and long-term therapeutic outcomes of plantaris tendon-related midportion Achilles tendinopathy treatment, in particular by comparing them with those obtained with other mini-invasive interventions.
跖肌腱疾病是跟腱中段肌腱病的一个众所周知的病因。跖肌腱增厚以及肌腱之间纤维组织形成是通常观察到的组织学异常。手术方法（刮除跟腱内侧和腹侧腱旁组织以及切除跖肌腱）已经显示出良好的临床效果；尽管如此，这些干预措施的成本效益比可能不佳，并且其可及性有限。经皮针电解是一种越来越多地被考虑用于治疗肌腱病及相关病症的微创消融技术。在此，我们介绍一种治疗与跖肌腱相关的跟腱中段肌腱病的新方法。该方法首先在超声引导下将一根未涂层的针（直径0.30 - 0.40毫米；长度30毫米）插入跖肌腱和跟腱之间。随后，局部施加直流电（强度2毫安），这会在靠近针的腱间组织处引发即时非热电化学消融，最终清理跖肌腱。为了进一步促进其松解，该方法的第二部分包括对跖肌腱外侧周边部分进行部分腱切断术。通常，整个过程不超过30分钟。经皮针电解可被视为手术的一种有效替代方法。本文介绍的门诊手术实际上操作安全且快速。此外，治疗后无需长时间暂停工作或体育活动。未来需要进行研究以确定与跖肌腱相关的跟腱中段肌腱病治疗的短期和长期疗效，特别是将其与其他微创干预措施所获得的疗效进行比较。
