Analysing the outcome of surgery for chronic Achilles tendinopathy over the last 50 years

Table 1 Functional classification of postsurgical outcome for Achilles tendinopathy[8]

Rating	Result
Excellent	No residual symptoms, sports performance unlimited
Good	Full return to the same sport as preoperatively; some stiffness after strenuous activities
Fair	Improvement with regard to the preoperative situation; still stiffness and aching relating to sports
Poor	No improvement at all

Table 2 Coleman Methodology Score criteria for studies reporting the outcomes of surgery for Achilles tendinopathy[9]

Section	Number or factor	Score
Part A - only one score to be given for each of the seven sections
Study size - number of tendons (N) (if multiple follow-up, multiply N by number of times subjects followed up)	> 60	10
	41-60	7
	20-40	4
	< 20, not stated	0
Mean follow-up (mo)	> 24	5
	12-24	2
	< 12, not stated, or unclear	0
Number of different surgical procedures included in each reported outcome. More than one surgical technique may be assessed but separate outcomes should be reported	One surgical procedure only	10
	More than one surgical procedure, but > 90% of subjects undergoing the one procedure	7
	Not stated, unclear, or < 90% of subjects undergoing the one procedure	0
Type of study	Randomized control trial	15
	Prospective cohort study	10
	Retrospective cohort study	0
Diagnostic certainty (use of preoperative ultrasound, MRI, or postoperative histopathology to confirm diagnosis)	In all	5
	In > 80%	3
	In < 80%, not stated, or unclear	0
Description of surgical procedure given	Adequate (technique stated and necessary details of that type of procedure given)	5
	Fair (technique only stated without elaboration)	3
	Inadequate, not stated, or unclear	0
Description of postoperative rehabilitation	Well described with > 80% of patients complying	10
	Well described with 60%-80% of patients complying	5
	Protocol not reported or < 60%-80% of patients complying	0
Part B - scores may be given for each option in each of the three sections if applicable
Outcome criteria (if outcome criteria is vague and does not specify subjects’ sporting capacity, score is automatically 0 for this section)	Outcome measures clearly defined	2
	Timing of outcome assessment clearly stated (e.g., at best outcome after surgery or at follow-up)	2
	Use of outcome criteria that has reported good reliability	3
	Use of outcome with good sensitivity	3
Procedure for assessing outcomes	Subjects recruited (results not taken from surgeons’ file)	5
	Investigator independent of surgeon	4
	Written assessment	3
	Completion of assessment by subjects themselves with minimal investigator assistance	3
Description of subject selection process	Selection criteria reported and unbiased	5
	Recruitment rate reported: > 80% or < 80%	5
	Eligible subjects not included in the study satisfactorily accounted for or 100% recruitment	5

Table 3 Mean Scores for each of the 10 Coleman Methodology Score criteria for all included studies

Methodology criteria (maximum score)	Mean		Range
	Score	SD
Part A
Study size (10)	4.5	4.6	0-10
Follow-up (10)	3.3	2.4	0-5
No. of procedures (10)	6.6	5	0-10
Type of study (15)	3.4	5.4	0-10
Diagnostic certainty (5)	1.9	2.5	0-5
Description of surgical technique (5)	4.1	1.8	0-5
Rehabilitation and compliance (10)	4.8	5	0-10
Part B
Outcome criteria (10)	4.7	3.7	0-10
Outcome assessment (15)	5.2	4.5	0-12
Selection process (15)	4.6	6	0-15
Methodology score (100)	40.1	18.9	2-79

Table 4 Coleman Methodology Scores for all included studies

Ref.	Year of study	Mean follow-up (mo)	N Tendons	% Success	Coleman Methodology Scores
Snook[10]	1972		4		3
Burry and Pool[11]	1973		5		2
Clancy et al[12]	1976		5		5
Denstad and Roaas[13]	1979		58		46
Gould and Korson[14]	1980	12			8
Kvist and Kvist[15]	1980		201	97	35
Leach et al[16]	1981		20		10
Subotnick and Sisney[17]	1986		42		15
Saillant et al[18]	1987	42	65	86	36
Schepsis and Leach[19]	1987	36	45	87	44
Nelen et al[8]	1989		143	67	41
Leppilahti et al[20]	1991		150	86	12
Anderson et al[21]	1992	52	48	94	27
Clement et al[22]	1992	69	14		13
Leach et al[23]	1992		12	85	8
Leppilahti et al[24]	1994	48	275	73	50
Schepsis et al[25]	1994		79	79	66
Aström and Rausing[26]	1995		163		43
Alfredson et al[6]	1996	12	13		60
Johnston et al[27]	1997	24	41		22
Maffulli et al[28]	1997	22	52	71	70
Morberg et al[29]	1997	72	64	67	74
Rolf and Movin[5]	1997	25	60	75	69
Alfredson et al[30]	1998	12	11		59
Maffulli et al[31]	1999	35	14	36	56
Paavola et al[32]	2000	5	142		59
Wilcox et al[33]	2000	14	20		32
Ohberg et al[34]	2001	60	24	92	65
Shalabi et al[35]	2001	24	15	87	51
Maquirriain et al[36]	2002	16	7		37
Paavola et al[37]	2002	7	42		46
Shalabi et al[38]	2002	24	15	80	51
Yodlowski et al[39]	2002	39	41		39
Chiara Vulpiani et al[40]	2003	156	86	88	35
Den Hartog et al[41]	2003	35	29	88	34
Saxena[42]	2003	56	37	100	17
Martin et al[43]	2005	41	44		52
Costa et al[44]	2006	90	21		27
Johnson et al[45]	2006	34	22		32
Maffulli et al[46]	2006	37	93	81	74
Wagner et al[47]	2006	40	81		29
Alfredson et al[2]	2007	6	20		61
Cottom et al[48]	2008	27	62	95	37
Hahn et al[49]	2008	46	13		38
Maffulli et al[50]	2008	40	86	73	79
Vega et al[51]	2008	24	8	100	51
Bohu et al[52]	2009	42	137		29
Thermann et al[53]	2009	6	8		37
Will et al[54]	2009	22	19		34
Duthon et al[55]	2011	24	17	79	48
van Sterkenburg et al[56]	2011	12	3	100	44
Maffulli et al[57]	2011	36	30	85	54
Sarimo et al[58]	2011	30	24	100	42
Oshri et al[59]	2012		21	62	43
Kiewiet et al[60]	2013	35	12		30
Maffulli et al[61]	2013	204	39	77	42
Maquirriain[62]	2013	92	27	96	47
Benazzo et al[63]	2014	48	52		60
Tallerico et al[64]	2014	14	11		28
Maffulli et al[65]	2015	54	18	100	38
Nawoczenski et al[66]	2015	18	13	85	52