Transosseous fixation in insertional Achilles tendonitis

Outcomes and Material Cost Comparison of Transosseous Versus Suture Anchor Fixation of the Achilles Tendon: A Retrospective Study

Insertional Achilles tendinopathy is a common pathology that may be resistant to conservative treatment requiring surgical intervention. Treatment often involves partial to complete detachment of the Achilles tendon, debridement, and reattachment. Although 50% of the tendon may be safely resected without significantly compromising strength, the addition of a lengthening procedure requires further reinforcement. We conducted a retrospective review of 43 procedures comparing outcomes of 16 single suture anchor procedures with 27 transosseous fixation procedures for reattachment of the Achilles. The suture anchor group utilized one of 2 different industry anchors while the transosseous group utilized sutures ranging in size from 2-0 to #2. Female patients contributed 67% of the procedures with 53% occurring on the left side. For each group the median preoperative pain score (scale 0-10) was 8 and the median of the lowest reported postoperative pain score was 0. The typical time to lowest postoperative pain was 10 weeks for the suture anchor group and 4 weeks for the transosseous group. Tourniquet time averaged 59.3 (12.9) minutes for the suture anchor group and 65.1 (16.4) for the transosseous group. There was a large difference in material costs between the suture anchor and transosseous groups which ranged from $364.51 to $448.51 and $99.80 to $104.00 respectively. With similar results on postoperative pain and adverse event rate to suture anchor fixation and lower material costs than anchor fixation, transosseous fixation remains a viable option for fixating the Achilles tendon to bone in treatment of insertional Achilles tendinopathy.

An Anatomic Single-Suture Trans-osseous Technique for the Repair of Acute Achilles Tendon Ruptures

Several surgical methods for the treatment of acute Achilles tendon ruptures have been described. Whether open or percutaneous, these methods may be subdivided into two categories: all-soft-tissue procedures or procedures with stabilization of the Achilles tendon directly on the os calcaneum. The former comprise end-to-end suturing of the tendon stumps, the latter include additional stabilization of the sutures on the calcaneus either with bone anchors or by means of trans-osseous sutures. We describe a new, simple, anatomic, trans-osseous suture technique to stabilize the Achilles tendon on the calcaneus.

Study of the clinical and functional results of open calcaneoplasty and tendinous repair for the treatment of the insertional tendinopathy of the Achilles' tendon

BACKGROUND AND OBJECTIVES

Insertional tendinopathy accounts for 23% of the pathology of the Achilles tendon. Surgery is indicated when conservative treatment of pain and functional limitation fails. Our objective is to analyse the clinical-functional results of surgical treatment with disinsertion, debridement and double row reattachment with high strength suture tape.

MATERIAL AND METHODS

We present 13 patients with insertional Achilles tendinopathy, treated between February 2015 and October 2016. In all of them we performed inverted T-tendon disinsertion, debridement and calcareoplasty followed by double row tendon re-anchorage, without knots, with high resistance suture tape. Functional results were assessed with the AOFAS scale before and after surgery, with an average follow-up of 22 months.

RESULTS

The patients, 11 males and 2 females, with an average age of 43 years, presented a preoperative AOFAS score of 34.77±10.1 that reached 90.85±7 points after the operation, with an average increase of 56.08 points (IC 95% 48.13-64.02; P<0.01). The time to return to sports activities was 19 weeks (16-22). There were no complications.

CONCLUSION

The technique we present reports excellent results as a surgical treatment of insertional Achilles tendinopathy with intralesional calcification; it allows a wide contact surface between bone and tendon and an earlier return to previous sports activity.

Liquifying PLDLLA Anchor Fixation in Achilles Reconstruction for Insertional Tendinopathy

Insertional Achilles tendinopathy (IAT) is a frequent cause of posterior heel pain and is often associated with Haglund's deformity. Surgical correction for refractory cases of IAT has been well studied; however, the method of tendon fixation to bone in these procedures remains controversial, and to date, no standard technique has been identified for tendon fixation in these surgeries. Often, after Haglund's resection, there is large exposed cancellous surface for Achilles reattachment, which may require unique fixation to optimize outcomes. Previous studies have consistently demonstrated improved patient outcomes after Achilles tendon reconstruction with early rehabilitation with protected weight bearing, evidencing the need for a strong and stable anchoring of the Achilles tendon that allows early weight bearing without tendon morbidity. In this report, we highlight the design, biomechanics, and surgical technique of Achilles tendon reconstruction with Haglund's deformity using a novel technique that utilizes ultrasonic energy to liquefy the suture anchor, allowing it to incorporate into surrounding bone. Biomechanical studies have demonstrated superior strength of the suture anchor utilizing this novel technique as compared with prior techniques. However, future research is needed to ensure that outcomes of this technique are favorable when compared with outcomes using traditional suture anchoring methods.

LEVELS OF EVIDENCE

Level V: Operative technique.