Short-term results of endoscopic calcaneoplasty and retrocalcaneal bursectomy for insertional Achilles tendinopathy

Although open surgery has traditionally been used as a surgical treatment for insertional Achilles tendinopathy, there is a possibility of serious complications (avulsion, scarring, contracture, sensory changes, and infection) due to the anatomical characteristics of the area. Endoscopic surgery has some advantages due to the smaller incision needed. The purpose of this study was to evaluate the effectiveness of endoscopic surgery in insertional Achilles tendinopathy. Twelve patients (15 feet) who underwent endoscopic surgery between 2015 and 2021 were included in this study. Clinical results were evaluated before and after surgery by visual analog scale (VAS) and, Ogilvie-Harris scores and complications. For radiological evaluation, the Fowler-Philip angle, and positive parallel pitch line were measured. VAS scores decreased from 7.6 preoperatively to 2.3 at the last postoperative follow-up, and Ogilvie-Harris values showed excellent results in 5 cases, good results in 8 cases, and fair results in 2 cases. In the radiographic results, there was no bone prominence above the Pavlov calcaneus pitch line in any case, and the Fowler-Philip angle decreased from an average of 57.5 degrees to 50.2 degrees. Only 1 patient underwent reoperation due to the recurrence of symptoms 33 months after the first surgery. After the second operation, the VAS score decreased to 3 points. No complications occurred. Endoscopic surgery is an effective and minimally invasive procedure, showing fewer complications and similar satisfaction as the open procedure. Therefore, it can be a good treatment option for patients with insertional Achilles tendinopathy as it provides the patient with a quick return to daily life.

Neglected Iatrogenic Flexor Hallucis Longus Tendon Rupture After Haglund's Endoscopic Surgery: A Case Report

Rupture of the flexor hallucis longus (FHL) tendon is a rare condition that can occur with direct or indirect trauma; most of the injuries are complete ruptures resulting from laceration. Endoscopic calcaneoplasty is used for treatment of symptomatic Haglund's deformity, and complications of this procedure are rare. Iatrogenic FHL tendon rupture occurring after endoscopic calcaneoplasty has not been reported previously. This case report presents a rare complication after endoscopic calcaneoplasty and the proper method of treatment.

Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty

BACKGROUND

Calcaneoplasty is a common procedure performed for the management of Haglund's syndrome when nonoperative management fails. Midline tendon-splitting and endoscopy are 2 common approaches to calcaneoplasty. Studies have suggested that an endoscopic approach may allow earlier return to activity and superior outcomes, but there are no biomechanical or clinical studies to validate these claims. The goal of this study was to quantify and compare Achilles tendon pullout strength following midline tendon-splitting and endoscopic calcaneoplasty in cadaveric specimens.

METHODS

Twelve match-paired cadaveric specimens were randomly divided into 2 groups: endoscopic and midline tendon-split. Following calcaneoplasty, fluoroscopy was used to match bone resection and the Achilles was loaded to failure in a mechanical testing system. A paired-samples t test was conducted to compare bone resection height, bone resection angle, load to failure, and mode of failure.

RESULTS

The endoscopic approach yielded a 204% greater postsurgical pullout strength for the Achilles tendon than the midline tendon-split (1368 ± 370 N vs 450 ± 192 N, respectively) (P < .05). There were no differences in resection angle or resection height. All specimens failed due to bone or tendon avulsion.

CONCLUSION

Endoscopic calcaneoplasty had more than 3 times greater pullout strength than the midline tendon-splitting approach.

CLINICAL RELEVANCE

This may allow earlier return to functional rehabilitation following endoscopic calcaneoplasty, but further studies are needed to determine if these differences are clinically significant. Further understanding of the time-zero biomechanics following calcaneoplasty may provide guidance regarding postoperative management with respect to surgical approach.

Retrocalcaneal Pain After Open Reduction and Internal Fixation of Avulsion Fracture of the Achilles Tendon Treated by Endoscopic Adhesiolysis and Endoscopic Calcaneoplasty: A Case Report

Avulsion fracture of the Achilles tendon is uncommon. Open reduction and internal fixation is indicated for displaced fracture in order to restore the normal function of the Achilles tendon. We present a patient with avulsion fracture of Achilles tendon that was complicated by the development of secondary Haglund's deformity and fibrous adhesion between the Achilles tendon and the calcaneus. He was successful treated by endoscopic calcaneoplasty and endoscopic adhesiolysis.

LEVELS OF EVIDENCE

Therapeutic, Level IV: Case report.

Retrocalcaneal pain after the repair of acute Achilles tendon rupture

Pain in the posterosuperior portion of the calcaneus can be caused by a retrocalcaneal bursitis, enlargement of the superior bursal prominence of the calcaneus, insertional Achilles tendinopathy, stress fracture of the calcaneus, or inflammation of an adventitious bursa between the Achilles tendon and the skin. Hypertrophied tendon impinging on the posterosuperior calcaneal tuberosity can be a cause of retrocalcaneal pain after repair of acute rupture of the Achilles tendon. This can be effectively treated by endoscopic calcaneoplasty.

LEVELS OF EVIDENCE

Therapeutic, Level IV, Case Report.