Wen Jimmy, Alam Meraj, Sedighi Romteen, Syed Burhaan, Khalil Ramy, Shehabat Mouhamad, Joy Bethany, Razick Daniel, Razick Adam, Frezza Eldo
California Northstate University College of Medicine, Elk Grove, CA, USA.
University of California Los Angeles, Los Angeles, CA, USA.
Foot Ankle Orthop. 2025 Jun 26;10(2):24730114251346791. doi: 10.1177/24730114251346791. eCollection 2025 Apr.
Achilles tendinopathy (AT) patients who are refractory or have a suboptimal response to traditional tendon loading rehabilitation may have an additional component of pain with the plantaris tendon. This systematic review aims to evaluate the efficacy and safety of the combination of Achilles tendon scraping (ATS) and plantaris tendon removal (PTR) for AT.
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Embase, and Cochrane Library for studies reporting on concurrent ATS with PTR for AT. Study variables included the number of patients, mean age, mean follow-up time, return to activity (RTA) or sport (RTS), pre- and postintervention patient-reported outcomes (PROs), and complications. A meta-analysis was performed for pre- and postintervention Victorian Institute of Sports Assessment-Achilles (VISA-A) scores.
Seven studies including 235 patients (291 tendons) with a mean age of 40.8 years (27.2-52) and a mean follow-up time of 23.2 months (6-69.6) were analyzed. Mean preoperative score VISA-A (5 studies), and visual analog scale (VAS) scores (2 studies) were 43.4 (0-74.1) and 6.6 (5.8-7.4), respectively. RTA (1 study) and RTS (4 studies) were 100% and 95.5%. Mean postoperative VISA-A and VAS scores were 92.7 (61-100) and 0.8 (0.8-0.8). Pooled VISA-A mean differences were statistically significant at 43.6 (95% CI: 41.0-46.3, < .00001). The complication and revision rates were 11 (3.8%) and 5 (1.7%), respectively.
ATS with PTR demonstrated promising preliminary results, with improved postoperative PROs, high reported rates of RTA/RTS, and low complication and revision rates. These findings should be interpreted cautiously given the limited available evidence and high study heterogeneity.
对于跟腱病（AT）患者，那些对传统肌腱负荷康复治疗无效或反应欠佳的患者，其跖肌腱可能存在额外的疼痛因素。本系统评价旨在评估跟腱刮擦术（ATS）联合跖肌腱切除术（PTR）治疗AT的疗效和安全性。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed、Embase和Cochrane图书馆进行系统评价，纳入报告ATS联合PTR治疗AT的研究。研究变量包括患者数量、平均年龄、平均随访时间、恢复活动（RTA）或恢复运动（RTS）情况以及干预前后患者报告结局（PROs）和并发症情况。对干预前后的维多利亚运动评估-跟腱（VISA-A）评分进行Meta分析。
分析了7项研究，共235例患者（291条肌腱），平均年龄40.8岁（27.2 - 52岁），平均随访时间23.2个月（6 - 69.6个月）。术前平均VISA-A评分（5项研究）和视觉模拟量表（VAS）评分（2项研究）分别为43.4（0 - 74.1）和6.6（5.8 - 7.4）。RTA（1项研究）和RTS（4项研究）分别为100%和95.5%。术后平均VISA-A和VAS评分分别为92.7（61 - 100）和0.8（0.8 - 0.8）。合并后的VISA-A平均差值具有统计学意义，为43.6（95%CI：41.0 - 46.3，P < 0.00001）。并发症发生率和翻修率分别为11例（3.8%）和5例（1.7%）。
ATS联合PTR显示出有前景的初步结果，术后PROs得到改善，RTA/RTS报告率较高，并发症和翻修率较低。鉴于现有证据有限且研究异质性较高，对这些发现应谨慎解读。
