SLR - October 2010 - Jacqueline Monroe
Reference: Yeap, E. J., Chong, K W., Yeo, W., & Rikhraj, I., S. (2009). Radiofrequency coblation for chronic foot and ankle tendinosis. Journal of Orthopaedic Surgery, 17 (3): 325-330.
Scientific Literature Reviews
Reviewed by: Jacqueline Monroe, DPM, PGY-1
Residency Program: OCPM-University Hospitals Richmond Medical Center
Podiatric Relevance:
Chronic foot and ankle tendinosis is a serious problem that many people must deal with on a daily basis. As podiatrists, it is vital to have the proper knowledge to treat this condition. There are many different modalities that can be used in the treatment of this condition, and the better these options are understood, the more likely an effective treatment will be found for each individual suffering from chronic foot and ankle tendinosis.
Methods:
This is a retrospective review of 7 men and 8 women (16 feet) between the ages 27 to 65 (mean age 52) on which radiofrequency coblation for chonic tendinosis was performed. The same surgeon operated on all patients from May 2007 to October 2008. Each patient had first undergone conservative therapy and their symptoms had been apparent for an average of 13 months. Coblation was performed using a radiofrequency probe with two wands (Topaz microdebrider) connected to a generator and timer. Microtenotomy was done at depths of 3 to 5 mm at 5 mm intervals. The patients were then placed in a short aircast for 6 weeks. Follow-up occurred at week 2, 4, 6, and month 3 and 6. The Visual Analogue Scale for pain (VAS), the Short Form questionnaire (SF-36) for quality of life, and the American Orthopaedic Foot and Ankle Society (AOFAS) scores for functional status were determined both before and after surgery. These scores were compared using the Wilcoxon signed rank test.
Results:
The median preoperative midfoot and hindfoot VAS scores were 5 and 7, while at the 6-month follow-up the mean for each was 0. At the 6-month follow-up, the median AOFAS midfoot and hindfoot scores improved from 48 and 38 preoperatively to 91 and 83. At the 6-month follow-up, the mean SF-36 scores all improved except for general health and role emotional. Expectations were met for 93% and 100% of the patients at postoperative months 3 and 6, and good-to-excellent satisfaction was met for 93% and 88%.
Conclusions:
The success rate for foot and ankle tendinopathy is about 50%, even after 12 to 16 weeks of conservative treatment. Surgical treatment is a good choice for many patients, but may require a prolonged recovery time. Radiofrequency coblation may stop or delay the progression of early posterior tibial tendon dysfunction. The disease state within the tendon is shortened and recovery is increased with the use of radiofrequency microtenotomy. The tendon should return to full function and strength after a shorter rehabilitation time and will likely be long term. These factors make it a good choice for the athlete who wishes to return to activity sooner. Due to earlier pain relief, patients may wish to return to activity prematurely, therefore, early protection of the foot and/or ankle is called for. Most of the patients in this study had other pathologies in addition to tendinopathy, which should also be treated for the best patient outcome. To determine whether the benefits of this procedure are longstanding, a longer-term follow-up is required.