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Vora A, Ingwer SJ, Withrow M, Denove N, Hauck O, Khoury A. Double-Row Achilles Insertional Repair With Rip-Stop Increases Construct Strength Compared to Traditional Techniques: A Biomechanical Study. Foot Ankle Int 2024; 45:535-541. [PMID: 38348561 DOI: 10.1177/10711007241227948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Although double-row suture-anchored (DRSA) techniques for Achilles insertional tendinosis has proven successful, a reoccurring failure mode not yet addressed is suture tearing through the tendon. This study aims to address suture tearing by incorporating a rip-stop element. Authors hypothesized that the Rip-Stop group would demonstrate increased strength compared with more traditional techniques. METHODS 12 paired cadaveric feet were used in this study (n = 24). One sample from each pair was assigned to receive the standard double-row (SDR) Achilles repair with 4.75-mm knotless anchors (n = 12). The control's matched sides were divided between 2 DRSA bridge groups: modified double-row (MDR) bridge with 3.9-mm anchors or rip-stop double-row (RS-DR) bridge repair with soft proximal anchors and 3.9-mm anchored distal row. In neutral position, specimens underwent 1000 cycles (20-100 N) followed by load to failure. Displacements, stiffness, ultimate load, and failure mode were recorded. RESULTS RS-DR had the lowest initial displacement values followed by SDR and MDR (1.3 ± 0.4, 2.7 ± 1.4, and 3.2 ± 1.3 mm, respectively). Significance was detected when comparing initial displacement of RS-DR to MDR (P = .038). Cyclic displacement was lowest for RS-DR, followed by MDR and SDR (1.6 ± 0.9, 2.2 ± 1.1, and 4.5 ± 3.2 mm, respectively). Cyclic stiffness was similar for RS-DR and MDR (89.1 ± 24.6 and 81.9 ± 5.6 N/mm, respectively). RS-DR ultimate load (1116.8 ± 405.7 N) was statistically greater than SDR (465.6 ± 352.7, P = .003). CONCLUSION RS-DR-repaired specimens demonstrated a decrease in displacement values and increased ultimate load and stiffness when compared to other groups. Results of this cadaveric model suggest that the addition of a rip-stop to DRSA Achilles repair is more impactful than anchor size. Limitations include that this was a time-zero biomechanical study, which cannot simulate the performance of the repairs during postoperative healing and recovery. CLINICAL RELEVANCE A rip-stop technique for Achilles repair effectively improves dynamic mechanical characteristics and may mitigate suture tearing through tendon in a patient cohort.
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Affiliation(s)
- Anand Vora
- Illinois Bone & Joint Institute, Libertyville, IL, USA
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Ptak NA, Rigby RB. Impact of BMI on the Surgical Management of Chronic Insertional Achilles Tendinopathy. J Foot Ankle Surg 2024; 63:333-336. [PMID: 38151114 DOI: 10.1053/j.jfas.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
Posterior heel pain secondary to insertional Achilles tendinopathy is a common condition that often times requires surgical management. Typically, this involves reflecting a portion of the Achilles tendon from its insertion to adequately debride devitalized or thickened tendon as well as any osseous prominence and then reattached into the calcaneus via suture anchors. Oftentimes, it is suggested that patients with an increased body mass index (BMI) have a higher risk of complications. However, there is no published evidence to support this claim. The present study is a retrospective review of 78 patients who underwent detachment/reattachment of the Achilles tendon for chronic insertional Achilles tendinopathy. Patients were separated into three groups based on BMI: normal, obese, and morbidly obese. The mean BMI of all patients included was 35.6 kg/m2 (range: 21.8-54.9, SD: 6.9). We compared complication rates between the groups and found no significant difference (p = .541). Patients in all groups also demonstrated statistically significant improvements in both American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores (Normal BMI: p = .002; Obese: p = <.001; Morbidly obese: p = <.001) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores (Normal BMI: p = .003; Obese: p = <.001; Morbidly obese: p = .001). In conclusion, the results of our study demonstrate that detachment/reattachment of the Achilles insertion in the management of insertional Achilles tendinopathy in obese and morbidly obese patients may be safe and effective without the risk of increased complications.
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Affiliation(s)
| | - Ryan B Rigby
- Logan Regional Orthopedics - Intermountain Healthcare, Logan, UT
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Liu Z, Hou G, Zhang W, Lin J, Yin J, Chen H, Huang G, Li A. Calcaneal tuberosity avulsion fractures - A review. Injury 2024; 55:111207. [PMID: 37984015 DOI: 10.1016/j.injury.2023.111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
Calcaneal tuberosity avulsion fracture, an extra-articular injury, is a rare fracture caused internally by Achilles tendon driven following intense contraction of gastrocnemius-soleus complex, and externally by low-energy (possibly high-energy). Moreover, the risk of injuries of the skin and Achilles tendon around calcaneal tuberosity is closely related to Lee classification and Carnero-Martín de Soto Classification of calcaneal tuberosity avulsion fracture. Although the diagnosis confirmed by X-ray, digital imaging and computed tomography (CT), magnetic resonance imaging (MRI) should also be used to evaluate soft tissue. In recent years, the understanding of this fracture has witnessed the development of different internal fixation devices and surgical procedures. These advances have been further elaborated scientifically in terms of their ability to provide stable fracture reduction ad resistance to Achilles tendon forces. In order to obtain a comprehensive knowledge of the disease, this article reviewed the new understanding of the anatomy, typing, risk factors, and treatment modalities of calcaneal tuberosity avulsion fracture in recent years.
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Affiliation(s)
- Zhiyi Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Guodong Hou
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wencong Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Junyan Lin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinrong Yin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
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DeVries JG, Scharer BM, Donnay RL, Romdenne TA. No Loss of Strength After Insertional Achilles Tendon Reconstruction With Single-Anchor or Double-Row Repair. J Foot Ankle Surg 2024; 63:22-26. [PMID: 37597583 DOI: 10.1053/j.jfas.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
Many different types of surgical repair for insertional Achilles tendinosis have been described. Strength after surgery is an essential factor for patient function and satisfaction. A retrospective series of patients that underwent surgery for insertional Achilles tendon surgery were contacted to come in for prospective strength testing, with the tester blinded to the type of surgery performed. Thirty-seven patients came in for testing, 24 with a single-anchor repair and 13 with a double-row repair. Strength of plantarflexion was tested at 60°/s and 120°/s and was compared. First each operative leg was compared to the nonoperative leg as a control. Then the percentage change, or symmetry, from the control leg to the operative leg was compared between those with a single-anchor and double-row repair. Satisfaction was also assessed with a simple questionnaire and compared the types of repair. The results demonstrated there was no statistically significant change in strength after surgery compared to the nonoperative leg, and there was no difference in limb symmetry between types of repair. Similarly, there was no difference between the groups in satisfaction. Our study showed that there is, on average, no loss of strength after insertional Achilles tendon surgery at an average follow-up of nearly 2 years, regardless of type of repair.
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Lee DH, Lee HS, Kong CG, Lee SW. Isolated Avulsion Fracture of the Tibial Tuberosity in an Adult Treated with Suture-Bridge Fixation: A Rare Case and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1565. [PMID: 37763684 PMCID: PMC10535247 DOI: 10.3390/medicina59091565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background and objectives: Isolated tibial tuberosity avulsion fractures are exceptionally uncommon among adults, with limited instances documented in published literature. Here, we describe a case of an isolated tibial tuberosity avulsion fracture in an adult that was treated successfully with the suture bridge repair technique. Patient concerns: A 65-year-old female visited the outpatient department with left knee pain after a slip and fall. Lateral radiographs and sagittal MR images of the left knee revealed the tibial tuberosity avulsion fracture, but the fracture line did not extend into the knee joint space. Surgical intervention was performed on the patient's knee using an anterior midline approach, involving open reduction and internal fixation. The avulsed tendon was grasped and pulled, and an appropriate suture location was identified. Using a suture hook, the suture was guided through the patellar tendon as near to its uppermost point of the fragment as achievable, and tied over tendon. A single suture limb from each anchor was fastened over the tibial tuberosity to the distally positioned foot print anchor, effectively anchoring the tibial tuberosity using the suture bridge technique. The patient started walking on crutches after one week and was able to walk independently with a brace after two weeks from the operation day. After three months, the patient had regained her mobility to the level prior to the injury and exhibited painless active range of motion from 0 to 130 degrees. Hardware positioning and bony union were maintained at the one-year follow-up. Conclusions: In our case, the open suture bridge fixation method for tibial tuberosity avulsion fractures produced satisfactory results. Open suture bridge fixation may be considered for isolated tibial tuberosity avulsion fractures in adults, especially when the avulsion tip is too small for screw fixation.
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Affiliation(s)
- Dong Hwan Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10, 63-Ro, Seoul 07345, Republic of Korea; (D.H.L.)
| | - Hwa Sung Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10, 63-Ro, Seoul 07345, Republic of Korea; (D.H.L.)
| | - Chae-Gwan Kong
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-Ro, Uijeongbu-si 11765, Republic of Korea
| | - Se-Won Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10, 63-Ro, Seoul 07345, Republic of Korea; (D.H.L.)
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Kelsey LTJ, Mombell LKW, Fellars CTA. The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study. Foot Ankle Spec 2023; 16:356-362. [PMID: 34931550 DOI: 10.1177/19386400211033693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair's maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. METHODS Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. RESULTS The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure (P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). CONCLUSION This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.
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Affiliation(s)
- Lt Thomas J Kelsey
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Lt Kyle W Mombell
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Cdr Todd A Fellars
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California
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Nakajima K. Minimally invasive surgeries for insertional Achilles tendinopathy: A commentary review. World J Orthop 2023; 14:369-378. [PMID: 37377992 PMCID: PMC10292061 DOI: 10.5312/wjo.v14.i6.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023] Open
Abstract
Studies of minimally invasive surgery for insertional Achilles tendinopathy are limited. To establish this surgery, the following techniques must be minimally invasive: Exostosis resection at the Achilles tendon insertion, debridement of degenerated Achilles tendon, reattachment using anchors or augmentation using flexor hallucis longus (FHL) tendon transfer, and excision of the posterosuperior calcaneal prominence. Studies on these four perspectives were reviewed to establish minimally invasive surgery for insertional Achilles tendinopathy. Techniques for exostosis resection were demonstrated in one case study, where blunt dissection around the exostosis was performed, and the exostosis was resected using an abrasion burr under fluoroscopic guidance. Techniques for debridement of degenerated Achilles tendon were demonstrated in the same case study, where the space left after resection of the exostosis was used as an endoscopic working space, and the degenerated Achilles tendon and intra-tendinous calcification were debrided endoscopically. Achilles tendon reattachment techniques using suture anchors have been demonstrated in several studies. However, there are no studies on FHL tendon transfer techniques for Achilles tendon reattachment. In contrast, endoscopic posterosuperior calcaneal prominence resection is already established. Additionally, studies on ultrasound-guided surgeries and percutaneous dorsal wedge calcaneal osteotomy as minimally invasive surgery were reviewed.
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Affiliation(s)
- Kenichiro Nakajima
- Center for Foot and Ankle Surgery, Department of Orthopedic Surgery, YashioCentral General Hospital, Yashio-shi 340-0814, Saitama, Japan
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Vesely BD, Reardon BK, Scott AT, Medda AW. Retrospective Comparison of Isolated Haglund's Deformity Surgery Versus Combined With Gastrocnemius Recession. J Foot Ankle Surg 2023:S1067-2516(23)00064-9. [PMID: 37012168 DOI: 10.1053/j.jfas.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 03/04/2023] [Indexed: 04/05/2023]
Abstract
Insertional Achilles tendonitis is a common pathology treated by foot and ankle surgeons that may require surgical intervention. Literature has shown good outcomes following detachment and reattachment of the Achilles for removal of the exostosis. However, there is minimal literature showing the impact of adding a gastrocnemius recession to the Haglund's resection. The goal of the present study was to retrospectively review the outcomes of an isolated Haglund's resection versus a Haglund's resection combined with a gastrocnemius recession. A retrospective chart review of 54 operative extremities was performed: 29 with isolated Haglund's resection and 25 with a Strayer gastrocnemius recession. We found similar decreases in pain between the 2 groups, 6.1 to 1.5 and 6.8 to 1.8 in the isolated Haglund's and Strayer's group, respectively. We found decreased postoperative Achilles rupture and reoperation rates in the Strayer group but this did not reach statistical significance. We found a statistically significant decreased rate of wound healing complications in the Strayer group, 4% in the Strayer group and 24% in the isolated procedure. In conclusion, adding a Strayer to a Haglund's resection was found to have a statistically significant decrease in wound complications. We recommend future randomized controlled studies to compare the use of a Strayer procedure on postoperative complications.
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Affiliation(s)
- Bryanna D Vesely
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
| | - Brennan K Reardon
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Aaron T Scott
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Ashleigh W Medda
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
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DeVries JG, Scharer BM. Double Row Fixation is More Costly and Does Not Have Clinical Benefit Over Single Anchor for Insertional Achilles Tendon Surgery. J Foot Ankle Surg 2023:S1067-2516(23)00007-8. [PMID: 36737321 DOI: 10.1053/j.jfas.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
Surgical repair of insertional Achilles tendinosis is indicated in the face of failed conservative measures. Several methods for this repair have been described, and the optimal method is not universally agreed upon. In addition, the cost of medical care is important, and should be considered when determining the surgical repair for each patient. The purpose of this study is to compare implant costs between a single anchor or 4 anchor, double row repair, and evaluate associated outcomes. A retrospective comparative trial was performed for this purpose. The entire study encompassed 110 patients, 78 with a single anchor repair, and 32 with a double row repair. The average implant cost of the single anchor repair was $391.18 ± $272.10 and the double row repair was $1811.2 9 ± $169.47, p < .001. The groups did not have a statistically significant difference in complications (9% with single anchor vs 6.3% with double row, p = 1.0) or revisions 6.4% with single anchor vs 3.1% with double row, p = .67). The only difference in demographics between the groups was that the single anchor group had a higher percentage of female patients (p = .04). While the double row repair has been shown to have favorable biomechanical results, the present study did not show a benefit in complications or revisions and was a more costly repair technique. Surgeons should take these findings in consideration when choosing the repair technique when surgery is indicated.
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Scott AT, Long CS, Jaramillo TJ, Lara DL, Marois AJ, Juneja P. Review of Achilles Tendon Reattachment Using Double-Row Knotted and Knotless Techniques in the Management of Insertional Achilles Tendinopathy. J Foot Ankle Surg 2022; 61:927-931. [PMID: 34998679 DOI: 10.1053/j.jfas.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/23/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
Insertional Achilles tendinopathy represents a chronic degenerative condition affecting the insertion of the Achilles. Surgery is indicated in recalcitrant cases and often involves extensive debridement followed by subsequent repair of the insertion. In the present study, we evaluate the results of knotted and knotless double-row suture systems for Achilles reattachment. Despite the popularity of double-row repairs, there is a relative paucity of clinic data regarding efficacy of the available implants. In a retrospective cohort study, 38 patients (40 Achilles tendons) who received double-row repairs between November 2012 and December 2016 were evaluated. In addition to demographic information, preoperative pain scores and symptom duration were recorded. Perioperative and postoperative records were reviewed, and telephone interviews were conducted to assess patient satisfaction, functional status, postoperative pain, and information regarding surgical complications. At a mean follow-up of 32.5 months, 35 (92.1%) patients reported satisfaction with the outcome. Decreased pain levels were reported in 38 (95%) ankles, with 21 (52.5%) ankles being rated pain-free postoperatively. Of the patients working prior to surgery, 20 (95.2%) were able to return to normal work duties, and all 11 (100%) patients who engaged in sports preoperatively were able to return to the same level of activity. Two patients developed postoperative infections, one of which required operative debridement. No Achilles avulsions were encountered. No significant differences were noted between the 2 operative techniques. Considering the available biomechanical data, along with high patient satisfaction rates and low rate of complications, double-row repair offers a viable option for recalcitrant insertional Achilles tendinopathy.
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Affiliation(s)
- Aaron T Scott
- Associate Professor, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Christina Sigur Long
- Podiatrist in Private Practice, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Todd J Jaramillo
- Podiatrist in Private Practice, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Daniel L Lara
- Resident, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anthony J Marois
- Resident, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Pallavi Juneja
- Resident, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
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Lewis TL, Srirangarajan T, Patel A, Yip GCK, Hussain L, Walker R, Singh S, Latif A, Abbasian A. Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1179-1184. [PMID: 35507118 DOI: 10.1007/s00590-022-03270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The clinical outcomes following surgical management of insertional Achilles tendinopathy (IAT) vary depending on the surgical technique used to reattach the Achilles tendon following debridement. The aim of this study was to investigate the clinical outcomes of patients with IAT who underwent surgical management with a double-row suture bridge technique used to reattach the Achilles tendon. METHODS A retrospective review of consecutive patients diagnosed with IAT, who underwent surgical management utilising a double-row suture bridge technique (Arthex Speedbridge), and a minimum of 3-month follow-up were included. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) Index score which is a patient reported outcome measure (PROM). Secondary outcomes included EuroQol EQ-5D-5L health-related quality of life PROM and complication rates. RESULTS Between July 2013 and June 2020, 50 consecutive patients (23 male; 27 female) were included. The mean age (± standard deviation) was 52.3 ± 11.3 (range 29.0-84.3). Pre- and post-operative PROM data were available for all cases. The mean follow-up was 2.4 ± 1.9 years. The MOXFQ Index score improved from 48.5 to 12.4 (p < 0.01), EQ-5D-5L improved from 2.7 ± 0.46 to 1.2 ± 0.37 (p < 0.01), and EQ-VAS improved from 48.0 ± 18.4 to 84.1 ± 12.6 (p < 0.01). Four patients had complications which were of minimal clinical relevance and caused no deviation from routine recovery. There were no cases of tendon rupture. CONCLUSION This study has demonstrated that surgical management of IAT is safe and effective with clinical improvement in both clinical and general health-related quality of life outcome PROMs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T L Lewis
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
| | - T Srirangarajan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Patel
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - G C K Yip
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - L Hussain
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - R Walker
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - S Singh
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Latif
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Abbasian
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
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Do pre-operative radiologic assessment predict postoperative outcomes in patients with insertional Achilles tendinopathy?: a retrospective database study. Arch Orthop Trauma Surg 2022; 142:3045-3052. [PMID: 33891177 PMCID: PMC9522703 DOI: 10.1007/s00402-021-03897-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/03/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Diagnosis and treatment of insertional tendinopathy of the Achilles tendon (IAT) remains a challenge. The aim of this study was to assess the influence of pre-operative radiological pathologies on the patient-reported outcomes following open debridement of all pathologies for IAT. MATERIALS AND METHODS In this IRB-approved retrospective correlation and comparative study, patients with pre-operative imaging were identified from the authors' retrospective IAT database comprising of 118 patients. All were treated by a standardized surgical treatment strategy utilizing a midline, transachillary approach and debridement of all pathologies. A total of fifteen radiologic parameters were measured on radiographs (RX) and MRI. The patient-reported outcomes were assessed using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-G) and the general health questionnaire SF-12 at a minimum follow-up of 12 months. The data are presented as mean ± SD (95% CI). RESULTS 88 patients (74.6%) with an average age of 50 ± 12 (47-52) years were included. Radiographs were available in 68 patients and MRI in 53. The mean follow-up was 3.8 ± 1.9 (3.4-4.3) years. The overall VISA-A-G was 81 ± 22 (77-86), the SF-12 PCS 54 ± 7 (52-55), and the SF-12 MCS 52 ± 9 (50-54) points. None of the assessed radiological parameters had a significant influence on the patient-reported outcome following surgical treatment for IAT. CONCLUSION In this retrospective correlation study, no significant association was found between preoperative radiographic and MRI radiologic parameters for IAT and postoperative patient-reported outcomes (VISA-A-G and SF-12).
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13
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Miller CP, McWilliam JR, Michalski MP, Acevedo J. Endoscopic Haglund's Resection and Percutaneous Double-Row Insertional Achilles Repair. Foot Ankle Spec 2021; 14:534-543. [PMID: 33840259 DOI: 10.1177/19386400211002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with nonsurgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double-row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection. The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using minimally invasive surgery techniques while also incorporating a percutaneous double-row suture anchor repair. The technique utilizes 4 portals to access 2 endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double-row suture anchor repair.Levels of Evidence: Level V.
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Affiliation(s)
- Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James R McWilliam
- New York Medical College, Valhalla, New York.,White Plains Hospital Physicians Associates, White Plains, New York
| | - Max P Michalski
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jorge Acevedo
- Department of Orthopedics, Southeast Orthopedic Specialists, Jacksonville, Florida
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14
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Thompson JM, Nguyen K, Ahluwalia J, Casciato D, Tewilliager T, So E, Prissel M. Surgical Takedown Approaches to Insertional Achilles Tendinopathy: A Systematic Review. J Foot Ankle Surg 2021; 60:1217-1221. [PMID: 34108118 DOI: 10.1053/j.jfas.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 04/22/2021] [Indexed: 02/03/2023]
Abstract
Various techniques of surgical detachment for treatment of insertional Achilles tendinopathy have been described, including lateral release, medial release, central tendon splitting (CTS), and complete detachment. A systematic review of electronic databases was performed, encompassing 17 studies involving 703 patients and 746 feet, to compare outcomes associated with surgical takedown techniques. Observed results include wound complication rates (CTS 2.8%; Lateral 0%; Medial 0.4%; Complete 1.3%), postoperative rupture rates (CTS 0.7%; Lateral 0.8%; Medial 0.7%; Complete 2.6%), rate of revision (CTS 0.4%; Lateral 0.9%; Medial 4.2%; Complete 2.6%), rate of infection (CTS 1.1%; Lateral 1.7%; Medial 3.7%; Complete 6.5%). Lateral takedown group was found to have a statistically significant lower rate of complications compared to the complete takedown group (p = .0029). In light of these results, it is recommended that patient characteristics such as case specific tendon pathology and calcaneal morphology take precedent in determining the surgical approach to Achilles takedown.
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Affiliation(s)
- John M Thompson
- Division of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH.
| | - Kevin Nguyen
- Division of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH
| | - Jaime Ahluwalia
- Division of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH
| | - Dominick Casciato
- Division of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH
| | - Tyler Tewilliager
- Division of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH
| | - Eric So
- Fellowship-Trained Foot and Ankle Surgeon, Bryan Health, Lincoln, NE
| | - Mark Prissel
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
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15
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Saxena A, Maffulli N, Jin A, Isa E, Arthur WP, Wahl A. Insertional Achilles Tendinopathy: Analysis of 166 Procedures and Return to Activity. J Foot Ankle Surg 2021; 60:1117-1123. [PMID: 34024676 DOI: 10.1053/j.jfas.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
The surgical procedure for Insertional Achilles tendinopathy (IAT) varies widely with no consensus as to approach and documenting return to activity (RTA). This study presents outcomes of surgery for IAT by a single surgeon, documenting activity level and return to activity. From January 2001 through January 2018, 166 procedures were reviewed. Surgery included debridement of the Achilles insertion, resection of the superior calcaneus and bursa, and re-attachment with suture anchors. There were 110 males and 56 females. The majority of patients in the entire cohort were runners (n = 54). The average age of the cohort was 50.3 ± 12.1 years (range 20-80). Average follow-up was 114.0 ± 63.5 months (range 6-222 months). Average RTA for males and females were 6.43 months and 7.22 months, (p = .2), respectively. There was no difference in RTA between patients who had calcific tendinosis (n = 84) and noncalcific tendinosis (n = 82). Complications were 2 infections, 2 DVTs, and 17 deep suture reactions with a total complication rate of 12.6%; there were no re-ruptures postoperatively. There was no significant difference in number of complications between absorbable and nonabsorbable suture in the anchors (p = .41). The average RM score was 1.5 ± 0.7. The RM scores were better for males (p = .002), but there were no differences in RTA or complications between sexes. Overall, 95.8% of the procedures resulted in improved outcome and ability to return to activity including sports. This retrospective investigation shows surgical intervention for IAT yields good results with an average return to activity including sports in approximately 7 months.
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Affiliation(s)
- Amol Saxena
- Sutter-PAMF, Department of Sports Medicine, Palo Alto, CA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England
| | | | - Eghosa Isa
- Attending Staff, Department of Podiatry, The Permanente Medical Group, Kaiser Permanente Sacramento, Sacramento, CA
| | | | - Alanna Wahl
- Student, Rosalind Franklin University, Chicago, IL
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16
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Lopes R, Ngbilo C, Padiolleau G, Boniface O. Endoscopic speed bridge: A new treatment for insertional Achilles tendinopathy. Orthop Traumatol Surg Res 2021; 107:102854. [PMID: 33578040 DOI: 10.1016/j.otsr.2021.102854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/26/2020] [Accepted: 06/10/2020] [Indexed: 02/03/2023]
Abstract
Surgical treatment may be indicated after failure of medical management of insertional Achilles tendinopathy, and may consist in simple calcaneoplasty, increasingly performed endoscopically, or in open detachment-reattachment. Isolated calcaneoplasty sometimes shows poor results in case of multiple overlooked lesions (bone, tendon, pre- or retro-tendinous bursitis). Detachment-reattachment may be indicated in case of tendon lesion, but incurred scar and infection related risk in up to 30% of cases in certain reports. In this context, we describe a new original technique using an endoscopic Achilles speed bridge, which we call the "snake technique" for the S-shaped order of performance of the 6 necessary approaches.
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Affiliation(s)
- Ronny Lopes
- Pied Cheville Nantes Atlantique, Clinique Brétéché, 3 Rue de la Béraudière, 44000 Nantes, France; Pied Cheville Nantes Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Cedric Ngbilo
- Centre Orthopédique SANTY, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Giovany Padiolleau
- Pied Cheville Nantes Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France
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17
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Haghverdian JC, Gross CE, Hsu AR. Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211050565. [PMID: 35097478 PMCID: PMC8544775 DOI: 10.1177/24730114211050565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.
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Affiliation(s)
| | - Christopher E. Gross
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew R. Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
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18
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Boniface O, Vervoort T. Endoscopic treatment of insertional Achilles tendinopathy: A cadaver feasibility study. Orthop Traumatol Surg Res 2021; 107:102893. [PMID: 33746072 DOI: 10.1016/j.otsr.2021.102893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/22/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION One treatment option in insertional Achilles tendinopathy is open reconstruction of the insertion, resecting the enthesophyte and posterosuperior calcaneal prominence and reinserting the tendon using anchors. Although classically performed as an open procedure, the necessary subcutaneous release and dissection can entail problems of healing in at-risk patients. HYPOTHESIS It is possible to perform Achilles disinsertion-reinsertion with posterosuperior calcaneal prominence resection endoscopically, without iatrogenic risk, enabling complete resection of the enthesophyte and posterosuperior calcaneal prominence and satisfactory reinsertion. MATERIAL AND METHODS An operative technique was developed, consisting in Achilles disinsertion-reinsertion with resection of the posterosuperior calcaneal prominence and enthesophyte endoscopically via 5 portals. A feasibility study was conducted in an anatomy laboratory on 10 foot specimens, assessing iatrogenic impact. Bone resection quality was assessed under endoscopic and fluoroscopic control. Reinsertion quality was assessed endoscopically and on dissection of the specimens. RESULTS In the 10 procedures, there were no failures. Resection of the calcifications and the calcaneal prominence was complete in all cases. Reinsertion was satisfactory in all cases. There were no iatrogenic neural lesions. DISCUSSION/CONCLUSION It was possible to perform endoscopic Achilles disinsertion-reinsertion with resection of the posterosuperior calcaneal prominence and enthesophyte. The procedure did not seem to increase iatrogenic risk, and enabled complete bone resection and satisfactory reinsertion. This endoscopic technique now needs to be validated clinically, with comparison versus open surgery. LEVEL OF EVIDENCE IV; cadaver study.
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Affiliation(s)
- Olivier Boniface
- Orthopédie, Clinique Générale d'Annecy, 4, Chemin de la Tour la Reine, 74000 Annecy, France.
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19
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Greiner F, Trnka HJ, Chraim M, Neunteufel E, Bock P. Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation. Foot Ankle Int 2021; 42:1115-1120. [PMID: 33843294 PMCID: PMC8446883 DOI: 10.1177/10711007211002814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. METHODS All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. RESULTS The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively (P< .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively (P< .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up (P< .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). CONCLUSION We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Fabian Greiner
- Department of Orthopaedics and
Trauma-Surgery, Medical University of Vienna, Vienna, Austria,Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Fabian Greiner, MD, Department of
Orthopaedics and Trauma-Surgery, Medical University of Vienna, Waehringer
Guertel 18-20, Vienna, 1090, Austria.
| | | | - Michel Chraim
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Fusszentrum Vienna, Vienna,
Austria
| | - Elena Neunteufel
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria
| | - Peter Bock
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Orthopoint Vienna, Vienna,
Austria
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20
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Arunakul M, Pholsawatchai W, Arunakul P, Pitakveerakul A. Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy. Foot Ankle Int 2021; 42:1121-1129. [PMID: 34024153 DOI: 10.1177/10711007211003871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients. METHODS We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Functional outcomes were measured by a visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM), and Short Form Health Survey (SF-36) at 3, 6, and 12 months postoperatively. The differences in outcomes were analyzed using multiple linear regression. RESULTS Eighteen and 31 patients underwent the conventional and accelerated protocols, respectively; their corresponding mean ages were similar, 53 and 57 years, as were all other baseline characteristics. The mean scores (conventional vs accelerated group) for VAS for pain, FAAM, and SF-36 in the conventional group at 3 months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points (P < .05 for each comparison). There were no statistically significant differences between the groups at 6 and 12 months postoperatively. All patients could perform the single heel raise test at 6 months, and none experienced complications. CONCLUSION In this small study, short-term functional outcomes were better in the accelerated group. More data are needed before the accelerated program can be recommended. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Marut Arunakul
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Waroot Pholsawatchai
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
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21
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Laumonerie P, Mattesi L, Patrick C, Tibbo ME, Ancelin D. Endoscopic resection of enthesopathy via a direct midline transtendinous approach with associated reattachment of the Achilles tendon (endo-REDMTART): a cadaveric feasibility study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1237-1245. [PMID: 34417896 DOI: 10.1007/s00590-021-03098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study was to determine the feasibility of an all-posterior endoscopic resection of enthesopathy via direct midline transtendinous approach with detachment and reattachment of the Achilles tendon (endo-REDMTART). MATERIALS & METHODS Endo-REDMTART was performed in 10 ankles by two foot and ankle surgeons. Posterolateral and posteromedial portals were utilized. Three accessory, more distal portals were utilized (one posterolateral, one posteromedial, and one midline transtendinous). We measured the quality of the resection of the calcaneal spur and the length of tendon that was able to be reattached to the calcaneus. RESULTS The procedure was successful in all 10 cases. The mean minimum thickness of resected calcaneal spur was 7 mm (5-9 mm) thick, and the mean anteroposterior distance was 23 mm (20-25 mm). In all 10 cases, the maximum distance between the distal Achilles tendon and calcaneus was 1 mm (0-1 mm), with good tendon-bone contact. CONCLUSIONS The data here suggest that endo-REDMTART is feasible. This procedure provides all of the advantages of endoscopic technique without compromising the efficacy of Haglund deformity resection. TRIAL REGISTRATION No Clinical Trials Registration or IRB is required. LEVEL OF EVIDENCE Anatomy study; cadaveric dissection.
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Affiliation(s)
- P Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pellegrin, Place Amélie Raba-léon, 33076, Bordeaux, France.
| | - L Mattesi
- I2R, Institut de Recherche Riquet, 31059, Toulouse, France.,Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
| | - Chaynes Patrick
- Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
| | - M E Tibbo
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - D Ancelin
- I2R, Institut de Recherche Riquet, 31059, Toulouse, France.,Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
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22
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Jarin IJ, Bäcker HC, Vosseller JT. Functional Outcomes of Insertional Achilles Tendinopathy Treatment: A Systematic Review. JBJS Rev 2021; 9:01874474-202106000-00008. [PMID: 34125735 DOI: 10.2106/jbjs.rvw.20.00110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Achilles tendinopathy is a common clinical problem that can be either insertional or noninsertional, and effective treatment of each type can vary. We sought to investigate the current evidence on different treatment methods for insertional Achilles tendinopathy with a focus on functional outcomes. METHODS We performed a systematic review of the available literature using the PubMed/MEDLINE and Cochrane Central Register of Controlled Trials databases. Data from included studies were categorized according to treatment method and reported with respect to functional outcomes and complications. RESULTS A total of 1,457 abstracts were reviewed; 54 studies with 2,177 patients met the inclusion criteria. Among the 54 studies, 6 operative techniques and 6 nonoperative treatments were evaluated. CONCLUSIONS Eccentric exercises and low-energy extracorporeal shockwave therapy (ESWT) have the greatest evidence for the initial management of insertional Achilles tendinopathy. ESWT has been increasingly studied in recent years, but more high-quality evidence is needed. Operative treatment with tenotomy, debridement, retrocalcaneal bursectomy, and calcaneal exostectomy is effective. Flexor hallucis longus tendon transfer may benefit cases of more severe disease. Minimally invasive procedures have a potential role in the treatment algorithm and require more rigorous study. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ian J Jarin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Henrik C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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23
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Abarquero-Diezhandino A, Vacas-Sánchez E, Hernanz-González Y, Vilá-Rico J. Study of the clinical and functional results of open calcaneoplasty and tendinous repair for the treatment of the insertional tendinopathy of the Achilles’ tendon. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Hörterer H, Baumbach SF, Oppelt S, Böcker W, Harrasser N, Walther M, Polzer H. Complications Associated With Midline Incision for Insertional Achilles Tendinopathy. Foot Ankle Int 2020; 41:1502-1509. [PMID: 32819163 DOI: 10.1177/1071100720943836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The midline-incision trans-achillary approach (MITA) is frequently used for addressing all pathologies of insertional Achilles tendinopathy (IAT). The aim of this study was to assess the complication rate and possible influencing factors following a MITA for IAT treatment. METHODS Presented is a retrospective cohort study with current follow-up. Patients treated surgically by a MITA, addressing all pathologies of IAT, between January 2010 and October 2016 at a single reference center with at least 12 months of follow-up were included. General demographics (age, sex, and body mass index), medical history, surgical details (individual and sum of pathologies addressed), and duration of in-hospital stay were assessed. Patient satisfaction, shoe conflict, current employment status, time to return to sports, and type of sports were recorded using a custom questionnaire. Standard statistics, chi-square, and t tests were performed using SPSS. A total of 118 patients (follow-up, 63.4%) with a mean age (± SD) of 50 ± 12 years and a mean final follow-up time (± SD) of 4.2 ± 2.1 were included. RESULTS Fourteen percent of patients had a minor complication, the majority (75%) of which were surgical site infections. Forty-one percent were limited in their shoe selection, and 32% reported a shoe conflict. Seventy-eight percent were very satisfied, and 89% would recommend the surgery. Neither the individual surgical procedures, their sum, nor any other parameter showed a significant influence on the complication rate. The only factor negatively affecting patient satisfaction was a shoe conflict (P < .001). CONCLUSION The MITA for IAT treatment showed a moderate minor complication rate with good midterm patient satisfaction. However, the approach might predispose patients to shoe conflict, which negatively influences their satisfaction. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Hubert Hörterer
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany.,Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Sebastian Felix Baumbach
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Sonja Oppelt
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Norbert Harrasser
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany.,Department of Orthopedics and Orthopedic Surgery, Julius Maximilian University, Würzburg, Germany
| | - Hans Polzer
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
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25
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Abarquero-Diezhandino A, Vacas-Sánchez E, Hernanz-González Y, Vilá-Rico J. Study of the clinical and functional results of open calcaneoplasty and tendinous repair for the treatment of the insertional tendinopathy of the Achilles' tendon. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:47-53. [PMID: 33177011 DOI: 10.1016/j.recot.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
- A Abarquero-Diezhandino
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Complejo Hospitalario Quirón Ruber Juan Bravo, Madrid, España.
| | - E Vacas-Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Complejo Hospitalario Quirón Ruber Juan Bravo, Madrid, España
| | - Y Hernanz-González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Vilá-Rico
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Complejo Hospitalario Quirón Ruber Juan Bravo, Madrid, España; Universidad Complutense de Madrid, Madrid, España
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Moen R, Hagenbucher JR, Shinabarger AB. Surgical Treatment of Insertional Achilles Tendinopathy: A Systematic Review. J Am Podiatr Med Assoc 2020; 110:447712. [PMID: 33179068 DOI: 10.7547/17-052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Insertional Achilles tendinopathy is a common complaint among patients. Oftentimes, conservative treatment is inadequate, and surgical treatment is required. However, there is no published consensus regarding surgical intervention in reference to insertional Achilles tendinopathy. METHODS The purpose of this systematic review was to evaluate the surgical management of insertional Achilles tendinopathy and report which surgical procedures provide the greatest pain reduction and improvement in functional outcome. A review of PubMed, OVID, Google Scholar, and Cochrane Controlled Trials Register was performed using a defined search strategy and inclusion criteria. RESULTS Of 2,863 articles identified using the defined strategy, 20 met the inclusion criteria (three prospective and 17 retrospective). Operative interventions included Achilles tendon debridement, reattachment with suture anchors, reconstruction with flexor hallucis longus tendon autograft or bone-patellar tendon autograft, and gastrocnemius recession. All of the studies, regardless of intervention, showed generalized improvement after surgery. Wide variation in outcome scoring systems prevented direct comparison between studies and interventions. CONCLUSIONS This systematic review did not identify a superior treatment for insertional Achilles tendinopathy but rather found that the surgical treatment should be based on the extent of tendon injury.
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Chen J, Sharma A, Akoh CC, Kadakia R, Parekh SG. Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries. Foot Ankle Int 2020; 41:1073-1078. [PMID: 32578440 DOI: 10.1177/1071100720935122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures. METHODS We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores. RESULTS The most frequent cases using the anchor included lateral ankle ligament reconstruction (n = 19), insertional Achilles repair (n = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty (n = 6), and plantar plate repair (n = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 (P < .001) and FAOS improved from 54.7 to 94.2 (P < .001). CONCLUSION This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Akhil Sharma
- Duke University Medical Center, Chapel Hill, NC, USA
| | - Craig Chike Akoh
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
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Phen HM, Manz WJ, Mignemi D, Greenshields JT, Bariteau JT. Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420926101. [PMID: 35097382 PMCID: PMC8564938 DOI: 10.1177/2473011420926101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.
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Abstract
Insertional Achilles tendinopathy is one of the most common Achilles tendon disorders and often results in substantial heel pain and functional disability. There is consensus that treatment of insertional Achilles tendinopathy should start with nonoperative modalities. Surgery should be reserved for patients who fail exhaustive conservative treatment for a period of 3 months to 6 months and include débridement of insertional calcifications. Intratendinous degenerative tissue should be débrided and any Haglund deformity resected. Different surgical techniques have been described for reattachment of the distal Achilles tendon. The authors' preferred surgical technique includes the knotless double-row footprint reconstruction. Postoperative complications are not rare.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Todd Ludwig
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Zhuang Z, Yang Y, Chhantyal K, Chen J, Yuan G, Ni Y, Liu D, Shi D. Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4920647. [PMID: 31531355 PMCID: PMC6720369 DOI: 10.1155/2019/4920647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/13/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. METHODS 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. RESULTS No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. CONCLUSIONS Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.
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Affiliation(s)
- Ze Zhuang
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Yang Yang
- Departments of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Kishor Chhantyal
- Departments of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Jianning Chen
- Departments of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Guohui Yuan
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Yirong Ni
- MOE Key Laboratory of Laser Life Science & SATCM Third Grade Laboratory of Chinese Medicine and Photonics Technology, College of Biophotonics, South China Normal University, Guangzhou 510631, China
| | - Dezhao Liu
- Departments of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Dehai Shi
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
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Bodendorfer BM, Michaelson EM, Shu HT, Apseloff NA, Spratt JD, Nolton EC, Argintar EH. Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis. Arthroscopy 2019; 35:2114-2122. [PMID: 31167738 DOI: 10.1016/j.arthro.2019.01.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA). METHODS Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ2-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ2-tests. RESULTS Sixty patients at a mean age of 29.50 ± 6.60 years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37 months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P = .457). Postoperative average daily (0.60 ± 1.25 vs 1.66 ± 1.90) and maximum daily pain (1.57 ± 1.83 vs 3.35 ± 2.28) were significantly lower for SA (P < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P = .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94 months; P = .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P = .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P = .100). CONCLUSIONS Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A..
| | - Evan M Michaelson
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Henry T Shu
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, U.S.A
| | - Nicholas A Apseloff
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - James D Spratt
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Esther C Nolton
- Department of Orthopaedic Surgery, Inova Fairfax Hospital, Falls Church, Virginia, U.S.A
| | - Evan H Argintar
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, U.S.A
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Ferguson A, Christophersen C, Elattar O, Farber DC. Achilles Tendinopathy and Associated Disorders. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419838294. [PMID: 35097320 PMCID: PMC8696945 DOI: 10.1177/2473011419838294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Degenerative disorders of the Achilles tendon are common, affecting up to 18% of the adult population. A thorough evaluation including a focused history, physical examination, and diagnostic studies helps in choosing the appropriate treatment. Initial treatment is usually nonoperative, consisting of activity modification, bracing, and physical therapy. Patents who fail nonoperative management may be treated operatively with a wide range of procedures from endoscopic surgery to open debridement and tendon transfer. Understanding a patient’s expectations and educating patients about potential treatments and their outcomes enables informed collaborative decision making. This article will review the evaluation and management Achilles tendinopathy and associated disorders.
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Affiliation(s)
- Adam Ferguson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Osama Elattar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel C. Farber
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hardy A, Rousseau R, Issa SP, Gerometta A, Pascal-Moussellard H, Granger B, Khiami F. Functional outcomes and return to sports after surgical treatment of insertional Achilles tendinopathy: Surgical approach tailored to the degree of tendon involvement. Orthop Traumatol Surg Res 2018; 104:719-723. [PMID: 29852319 DOI: 10.1016/j.otsr.2018.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/22/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Insertional Achilles tendinopathy is a generic term that encompasses several types of ailments. While conservative treatment is less effective than for conditions isolated to the tendon body, there is no consensus as to the best type of surgical care. HYPOTHESIS Surgical treatment for insertional Achilles tendinopathy that is tailored to the severity of the tendon involvement will lead to satisfactory functional outcomes. MATERIAL AND METHODS Forty-six patients were included with an average age of 44.1±11.4 years and a mean preoperative AOFAS score of 62.2±11.7. The mean duration of symptoms before the surgery was 33.1±24 months. The inclusion criteria were pain at the tendon insertion and failure of at least 6 months of conservative treatment. Tendon involvement was evaluated preoperatively using MRI and confirmed intraoperatively after debridement. The primary treatment in all patients was resection of the calcaneal abnormality. Depending on the degree of tendon involvement, debridement or detachment/reattachment were also performed. The minimum follow-up was 12 months. RESULTS The mean follow-up was 33±13.5 months. None of the patients were lost to follow-up. The mean AOFAS score was 93.7±7.3 at the last follow-up. The ATRS and VISA-A scores were 89.2±4.1 and 89±3.2, respectively. The sports participation level was the same or higher in 71.7% of cases. Increased preoperative passive dorsiflexion was statistically correlated with the degree of tendon involvement. CONCLUSION Surgery for insertional Achilles tendinopathy led to good functional outcomes and satisfactory return to sports when the surgical care was tailored to the sdegree of tendon involvement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexandre Hardy
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Romain Rousseau
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Samir-Pierre Issa
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Antoine Gerometta
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Hugues Pascal-Moussellard
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Benjamin Granger
- Département de biostatistique et de santé publique, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Frédéric Khiami
- Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M. Endoscopic Achilles Tendon Augmentation With Suture Anchors After Calcaneal Exostectomy in Haglund Syndrome. Foot Ankle Int 2018. [PMID: 29519149 DOI: 10.1177/1071100717750888] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Haglund syndrome is a common cause of heel pain. Risk for tendon detachment after calcaneoplasty can exist. Open Achilles tendon detachment, calcaneoplasty, bursectomy, pathologic tendon-tissue debridement, and tendon reattachment of the Achilles tendon is a common surgical management of Haglund syndrome combined with insertional Achilles tendinopathy. The aim of this study was to describe the endoscopic calcaneoplasty and anchor suture augmentation of the Achilles insertional area, and the results obtained in patients with an increased risk of Achilles tendon rupture after calcaneoplasty. METHODS Between 2012 and 2015, endoscopic calcaneal ostectomy and suture anchor augmentation was performed in 12 patients. Mean age was 44.8 years (range, 35-52 years), and mean follow-up was of 33.5 months (range, 21-46 months). RESULTS The mean AOFAS score increased from 70 preoperatively (range, 55-85) to 92 (range, 63-100) at final follow-up. The mean VISA-A questionnaire increased from 34 preoperatively (range, 15-63) to 92 (range, 30-100) at follow-up. No major complications were reported. All patients returned to their daily activities without limitations, but 2 described complaints with sports activity. CONCLUSION Endoscopic calcaneoplasty and tendon augmentation with suture anchor for the treatment of Haglund syndrome was a reproducible and safe technique that offered the advantages of the endoscopic technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jordi Vega
- 1 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,2 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics Human Anatomy Unit, University of Barcelona, Barcelona, Spain
| | - Albert Baduell
- 1 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,3 Department of Orthopaedic and Traumatology, Hospital of Figueres, Figueres, Girona, Spain
| | - Francesc Malagelada
- 4 Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Miki Dalmau-Pastor
- 2 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics Human Anatomy Unit, University of Barcelona, Barcelona, Spain.,6 Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
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Boden SA, Boden AL, Mignemi D, Bariteau JT. Liquifying PLDLLA Anchor Fixation in Achilles Reconstruction for Insertional Tendinopathy. Foot Ankle Spec 2018; 11:162-167. [PMID: 29134816 DOI: 10.1177/1938640017740676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Stephanie A Boden
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Allison L Boden
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Danielle Mignemi
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
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Reattachment using the suture bridge augmentation for Achilles tendon avulsion fracture with osteoporotic bony fragment. Foot (Edinb) 2017; 31:35-39. [PMID: 28441542 DOI: 10.1016/j.foot.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
Abstract
Although avulsion fractures of the calcaneal tuberosity are rare injuries, these can be a challenging problem with frequent complications, such as loss of reduction and soft tissue problem. Anatomical reduction and internal fixation are indicated to avoid these pitfalls and to restore function of the triceps surae. However, the best fixation device and operative technique are still controversial. A case that achieved satisfactory clinical outcome through a reattachment technique using the suture bridge augmentation for Achilles tendon avulsion fracture with osteoporotic bony fragment is presented.
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38
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Mineta K, Suzue N, Matsuura T, Sairyo K. Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:310-4. [PMID: 27644578 DOI: 10.2152/jmi.63.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.
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Affiliation(s)
- Kazuaki Mineta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
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A Proposed Staging Classification for Minimally Invasive Management of Haglund's Syndrome with Percutaneous and Endoscopic Surgery. Foot Ankle Clin 2016; 21:641-64. [PMID: 27524710 DOI: 10.1016/j.fcl.2016.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Haglund's syndrome encompasses several different pathologies, including Haglund's deformity, insertional Achilles tendonopathy, retrocalcaneal bursitis, and superficial bursitis. Traditionally treated with open surgery, there is increasing interest in a more minimally invasive approach to this difficult region to reduce complications and improve the rate and ease of recovery. We review the evidence available for 2 of these techniques: the endoscopic calcaneoplasty and percutaneous Zadek's calcaneal osteotomy (also known as Keck and Kelly's osteotomy). The senior author's classification for management of the condition is presented as well as describing his operative technique for these procedures.
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40
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Byrne PA, Hopper GP, Wilson WT, Mackay GM. Knotless Repair of Achilles Tendon Rupture in an Elite Athlete: Return to Competition in 18 Weeks. J Foot Ankle Surg 2016; 56:121-124. [PMID: 27555353 DOI: 10.1053/j.jfas.2016.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Indexed: 02/03/2023]
Abstract
Rupture of the Achilles tendon is an increasingly common injury, particularly in physically active males, and current evidence favors minimally invasive surgical repair. We describe the case of a 36-year-old male elite bobsled athlete with complete rupture of the Achilles tendon. He was treated with surgical repair of the ruptured tendon using an innovative, minimally invasive procedure based on an internal bracing concept and was able to undergo early mobilization and aggressive physiotherapy rehabilitation. His recovery was such that he returned to training at 13 weeks postoperatively and participated in an international competition at 18 weeks, winning a World Cup silver medal. He subsequently raced at the 2014 Winter Olympic Games at 29 weeks after surgery. At >2 years since his injury, he has experienced no complications or reinjury. This represents an exceptional recovery that far exceeds the standard expected for such injuries. The use of this technique for athletes could enable accelerated return to sporting activity and attainment of their preinjury activity levels.
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Affiliation(s)
- Paul A Byrne
- Foundation Doctor, NHS South-East Scotland, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
| | - Graeme P Hopper
- Specialist Registrar, Trauma and Orthopaedics, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - William T Wilson
- Specialist Registrar, Honorary Clinical Lecturer, University of Glasgow, Glasgow, United Kingdom
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Ettinger S, Razzaq R, Waizy H, Claassen L, Daniilidis K, Stukenborg-Colsman C, Plaass C. Operative Treatment of the Insertional Achilles Tendinopathy Through a Transtendinous Approach. Foot Ankle Int 2016; 37:288-93. [PMID: 26443697 DOI: 10.1177/1071100715609921] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Different operative techniques have been proposed for the treatment of insertional Achilles tendinopathy (IAT), with often disappointing results. The aim of this study was to evaluate the outcome of the transtendinous approach in IAT. METHODS Forty patients operated with an IAT between 2010 and 2011 were included in this retrospective study. The mean follow-up was 15.6 (±3.7, 12-27) months. Indication for surgery was IAT with failed conservative therapy. Using a transtendinous approach, the Achilles tendon (AT) was partially detached and all pathologic tissues were debrided. The AT was reinserted using different anchor techniques. Clinical data were recorded using examination and clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS], Foot and Ankle Outcome Score [FAOS], Numerical Rating Scale [NRS], and Short Form-36 [SF-36]). RESULTS The mean AOFAS hindfoot score improved from 59.4 preoperatively to 86.5 postoperatively (P < .05). All FAOS subscales, NRS pain scores, and pain and function subscales of SF-36 improved significantly. The median time of return to work and sports was 14.5 (±17.6; 2-82) and 22.7 (±13.4; 7-58) weeks. Three patients had superficial wound healing difficulties but required no revision. One patient had to be revised due to a hematoma. Patients treated with 2 suture anchors or double-row fixation technique improved significantly (P < .05) compared to those with single anchor fixation, regarding AOFAS score (79.6 and 90.2) and FAOS subscale scores. Eighty-three percent of the patients showed good to excellent results. CONCLUSION The transtendinous approach allowed access to all associated pathologies in IAT. It had relatively few complications and lead to good clinical results. LEVEL OF CLINICAL EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Sarah Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Germany
| | - Rameez Razzaq
- Department of Trauma Surgery, Helios Clinic, Hildesheim, Germany
| | - Hazibullah Waizy
- Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany
| | - Leif Claassen
- Department of Orthopedic Surgery, Hannover Medical School, Germany
| | | | | | - Christian Plaass
- Department of Orthopedic Surgery, Hannover Medical School, Germany
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Biomechanical comparison of three methods for distal Achilles tendon reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:3756-60. [PMID: 25026935 DOI: 10.1007/s00167-014-3176-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the load at failure and stiffness associated with three surgical techniques for distal Achilles tendon reconstruction (AT). METHODS Nine matched pairs of fresh-frozen human cadaveric ATs were divided into three groups. Distal AT reconstruction was performed using suture anchors or one of two lengths of tendon overlap (10 or 5 mm). Each tendon was loaded to failure. The load at failure (N), stiffness (N/mm), and mode of failure were recorded. Differences in load at failure and stiffness were analysed. RESULTS Mean load at failure was significantly higher in the 10-mm group than in the 5-mm group (p < 0.05) or the suture-anchor group (p < 0.05). Load at failure did not differ significantly between the suture-anchor and 5-mm group, and stiffness did not differ significantly between any two groups. In the 10- and 5-mm groups, failure was caused by the grafts pulling out through the substance of the AT. Modes of failure varied in the suture-anchor group. CONCLUSIONS The load at failure was higher in the 10-mm group than in the 5-mm and suture-anchor groups. Although all three surgical techniques provide sufficient primary load-bearing ability, the 10-mm tendon-overlap technique may be more conducive to early post-operative rehabilitation.
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Yamaguchi S, Endo J, Yamamoto Y, Sasho T. Double-Row Bridging Suture Fixation Augmented With Double Krackow Suture for the Repair of Avulsion of the Ossified Achilles Tendon: A Technical Tip. Foot Ankle Int 2015; 36:849-52. [PMID: 25743427 DOI: 10.1177/1071100715575001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Endo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Fixation of posterior process fractures of the olecranon using a modified suture bridge technique: report of 2 cases. J Hand Surg Am 2014; 39:2434-7. [PMID: 25240432 DOI: 10.1016/j.jhsa.2014.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Abstract
We encountered 2 patients with posterior process fractures of the olecranon and fixed the fragment using a modified suture bridge method without a metallic implant. The suture anchor was inserted distally through the fracture plane, and the small tip of proximal olecranon was reduced to the ulna. Computed tomography revealed bony union 4 and 5 months later. At the 1-year postoperative follow-up examination, the clinical outcomes were satisfactory in both patients. This suture bridge technique was reliable for small fragment fixation in posterior process fracture of the olecranon based on the tension band theory with no problems induced by metallic hardware.
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A young athlete with heel pain. JAAPA 2014; 27:52-5. [PMID: 24662260 DOI: 10.1097/01.jaa.0000444743.54787.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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