Brisement

What is brisement?

Brisement is the injection of fluid into the space between a tendon and its lining, or sheath.
 

What are the goals of brisement?

This procedure is performed to break up scar tissue and stimulate healing of a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.
 

When is brisement indicated?

Brisement may be considered for patients with painful inflammation of the Achilles paratenon when it has not responded to conservative treatment. The paratenon is the layer of tissue that wraps around the true fibers of the tendon. In some cases, there may be crackling about the tendon with activity.
 

When should I avoid brisement?

Brisement is unlikely to work in advanced cases with associated degeneration and thickening of the actual Achilles tendon fibers. It should not be done if an infection is present.
 

What can I expect during the procedure?

This is an outpatient procedure that is typically performed in the office. Ultrasound guidance may be used to assist in proper placement.
 
The patient lies on their stomach. The skin around the Achilles tendon and calf is cleaned. A needle is inserted into the space between the Achilles tendon and sheath. Then a small amount of fluid is injected. An adhesive bandage is applied to the injection site.
 

What happens after brisement?

After the procedure, patients are able to walk immediately. The pain is minimal.  It does not require a hospital admission.
 

Potential Complications

There is a low risk for potential injection site pain, bleeding and infection. There is also a very low risk of tendon damage.
 

Frequently Asked Questions

Is cortisone ever added to the injection solution?
The use of cortisone is associated with an increased risk of rupture of the Achilles tendon. Therefore, steroid injections are not recommended in this area.
 

Associated Articles

Achilles Tendinitis

 

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.​​​