For citation purposes: Alfredson H. Intratendinous surgery and injection treatment for midportion Achilles tendinopathy: a critical review. OA Sports Medicine 2013 Nov 26;1(3):22.

Critical review

Treatment Techniques

Intratendinous surgery and injection treatment for midportion Achilles tendinopathy: a critical review

H Alfredson

Authors affiliations

Department of Surgical and Perioperative Science, Sports Medicine Unit, Umeå University, SE-90187 Umeå, Sweden

* Corresponding author Email:



Treatment of chronic painful midportion Achilles tendinopathy is known to be difficult. Multiple non-tendon-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, it has become increasingly popular to try injections of PRP and autologous blood, and intratendinous open surgery is indicated finally. There is little, if any, scientific evidence from human studies backing up intratendinous injection treatment, and intratendinous surgical treatment can also be questioned. The aim of this critical review is to discuss intratendinous surgery and intratendinous treatment with injection for midportion Achilles tendinopathy.


Based on a recent research using immunohistochemical analyses of tissue biopsies from patients with midportion Achilles tendinopathy, new non-tendon-invasive treatment methods combined with short rehabilitation periods have been invented. These methods have shown good clinical results, few complications and decreased tendon thickness along with improved tendon structure, over time.

The knowledge about innervation patterns, tendon cells and potentials in the soft tissue on the ventral (deep) side of the Achilles tendon midportion, along with good results using treatment methods focussing on the outside of the tendon, questions the use of tendon-invasive treatment methods for midportion Achilles tendinopathy.


A new science backing invasive treatment outside the tendon and newly-invented methods such as ultrasound and Doppler-guided surgical scraping treatment have shown promising results.

Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY)