Retrocalcaneal Enthesophyte Resection With Functional Lengthening of the Achilles Tendon and Buried Knot Technique: A Case Series

Retrocalcaneal Enthesophytes and Radiographic Predictors of Failing Nonoperative Management in Insertional Achilles Tendinopathy: A Retrospective Cohort Study

BackgroundThe purpose of this study was to investigate the relationship between radiographic characteristics of retrocalcaneal enthesophytes in insertional Achilles tendinopathy (IAT) and likelihood of failing nonoperative management.MethodsA retrospective cohort study of 200 patients diagnosed IAT with symptomatic enthesophytes were identified and separated into operative and nonoperative cohorts. All patients had lateral weight-bearing radiographs which were used to measure the calcaneal spur-to-skin distance (CSK), calcaneal spur width (CSW), calcaneal spur height (CSH), and the Fowler-Philip angle (FPA). Demographic and radiographic parameters were compared between both groups. Multivariate regression analysis was performed to identify independent risk factors associated with failing nonoperative management.ResultsThe operative group had significantly smaller CSK (6.0 mm vs 6.6 mm; P = .02), larger CSW (7.9 mm vs 6.2 mm; P < .001), and larger CSH (14.1 mm vs 11.1 mm; P < .001) compared with the nonoperative group. There was no significant between-group difference in FPA (61.9° nonoperative vs 63.3° operative; P = .052). Multivariate logistic regression analysis demonstrated CSK, CSW, and CSH as independent risk factors for failing nonoperative management.ConclusionRadiographic measurements of retrocalcaneal enthesophytes are a simple and reliable method for predicting which patients have a higher likelihood of failing nonoperative management of IAT.Level of Evidence:III, retrospective cohort study.

Impact of BMI on the Surgical Management of Chronic Insertional Achilles Tendinopathy

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.

Comparison between achilles tendon reinsertion and dorsal closing wedge calcaneal osteotomy for the treatment of insertional achilles tendinopathy: A meta-analysis

BACKGROUND

The debridement and Achilles tendon reinsertion (DATR) have been the most common surgical approach for the treatment of Insertional Achilles Tendinopathy (IAT), while dorsal closing wedge calcaneal osteotomy (DCWCO) has recently gained popularity as an alternative surgical option. This study aimed to systematically review the published literature on both surgical techniques and compare their clinical outcomes and complication rates.

METHODS

A systematic review was performed according to the PRISMA guidelines using Medline, Embase, and Scopus databases. The inclusion criteria encompassed clinical studies reporting functional outcomes and complications, with a minimum of 10 patients and at least 12 months of follow-up.

RESULTS

Seven studies (n = 169) were included for the analysis of DATR, and eight studies (n = 227) were included for the analysis of open DCWCO. Both groups showed a similar improvement in AOFAS score. The overall complication rates were 16.6% in the DATR group and 9.2% in the DCWCO group, but the difference was not statistically significant. However, there was a significantly higher incidence of wound complications in the DATR group (10.1%, 95% C.I.: 4.7-15.6) compared to the DCWCO group (2.5%, 95% C.I.: 0.6-4.4) as the confidence intervals did not overlap.

CONCLUSIONS

Clinical outcomes and overall complication rates of both techniques were comparable, although DCWCO had a lower incidence of wound complications. Further research should be focused on prospective studies comparing the two techniques to corroborate the current findings.

LEVEL OF EVIDENCE

Level IV; meta-analysis.