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Recent research has suggested a combined role of the plantaris tendon and neovascularization for Achilles tendinopathy recalcitrant to nonoperative management. The aim of our study was to determine if addressing both these issues improved symptoms of Achilles tendinopathy. We report on the results of a prospective case series involving 2 cohorts of patients between February 2011 and February 2015 undergoing this combined technique. One cohort included recreational athletes (group A), the second included patients who undertook minimal recreational activity (group B). In group A there were 19 patients (25 tendons). The mean age at surgery was 44 years (range, 20 to 55 y). The mean follow-up was 21 months (range, 7 to 38 mo). Patients were satisfied with the results in 21 of the 25 tendons (84%). The mean Victorian Institute of Sports Assessment-Achilles improved from 51 to 90 following surgery (P<0.001). One case was revised. In group B there were 7 patients (9 tendons). Patients were satisfied in 7 of the 9 cases. These results support the use of this combined procedure in recreational athletes with failed nonoperative management. We believe surgery provides a healthier environment for conservative load-based rehabilitation. In the nonathletic population results are less consistent.Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.