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Hall S, Schipper ON, Kaplan JRM, Johnson AH, Gonzalez TA, Vulcano E. Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy. Foot Ankle Int 2024; 45:931-939. [PMID: 39219246 PMCID: PMC11408980 DOI: 10.1177/10711007241252803] [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: 09/04/2024]
Abstract
BACKGROUND Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up. METHODS One hundred eight cases treated with percutaneous ZO with a minimum 2-year follow-up were retrospectively reviewed. Postoperative complications and patient satisfaction were evaluated. Foot Function Index (FFI) and visual analog scale (VAS) scores were recorded at preoperative and follow-up appointments to measure patients' functional outcomes and pain, respectively. RESULTS Mean follow-up was 41.2 months (range, 24-65). Mean age was 51.8 years (range, 28-81). The mean FFI score improved from 56.1 (range, 47-88) to 11.0 (range, 7-59) postoperatively (P < .001). The mean VAS score improved from 7.7 (range, 5-10) to 0.4 (range, 0-7) postoperatively (P < .001). The overall complication rate was 3.8% (n = 4). Of 104 cases, 98.1% of patients said they were satisfied with their procedure (n = 102) when asked if they were satisfied with their ZO and recovery. CONCLUSION We found the percutaneous ZO to be a safe and effective intervention for treatment of IAT. At a minimum of 2-year follow-up, this intervention is associated with minimal complications, improved function, reduced pain, and a high rate of patient satisfaction.
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Affiliation(s)
- SarahRose Hall
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | | | | | | | - Tyler A Gonzalez
- University of South Carolina, School of Medicine, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
| | - Ettore Vulcano
- Columbia University Division of Orthopedics at Mount Sinai Medical Center, Miami Beach, FL, USA
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Drakos MC. MIS Osteotomies: Expanding the Scope of Treatment. Foot Ankle Int 2024; 45:940-942. [PMID: 39219242 DOI: 10.1177/10711007241268177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
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Kaplan JRM, Hall S, Kumar P, DiTommaso RM, Giles SS, Gonzalez TA, Haupt E. Dorsal calcaneal wedge removal in zadek osteotomy: A cadaveric study. Foot Ankle Surg 2024; 30:516-519. [PMID: 38692981 DOI: 10.1016/j.fas.2024.04.004] [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: 12/18/2023] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Insertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO. METHODS The ZO was performed on six cadaveric specimens. A 7.5 mm and 15 mm wedge osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen's d analysis. RESULTS Maximal DF was 110.87 ± 12.97 deg in the pre-osteotomy state. Removal of a 7.5 mm wedge improved DF by 8 deg to a mean 102.93 ± 13.81 deg (p = 0.08). Removal of a 15 mm wedge improved DF by 16 deg to a mean 95.96 ± 11.41 deg (p = 0.003). Cohen's d and effect size calculation demonstrated a 7.5 mm wedge to have a small effect on DF, while a 15 mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5 mm wedge, or 15 mm wedge positions. ICC was 0.96. CONCLUSION Based on the results presented in this study, removal of a 15 mm wedge with ZO yields significant and greater improvement in ROM than a 7.5 mm wedge. We hope the current study will better inform preoperative planning for ZO. STUDY TYPE Prospective Cadaver Study. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - SarahRose Hall
- University of South Carolina, School of Medicine, 6311 Garners Ferry Rd., Columbia, SC 29209, USA.
| | - Padam Kumar
- Prisma Health Orthopedics - Lexington, 104 Saluda Pointe Drive, Lexington, SC 29072, USA.
| | - Rita M DiTommaso
- Mayo Clinic Florida,1515 Sw Archer Rd, Gainesville, FL 32608, USA.
| | | | - Tyler A Gonzalez
- University of South Carolina, School of Medicine, 6311 Garners Ferry Rd., Columbia, SC 29209, USA; Prisma Health Orthopedics - Lexington, 104 Saluda Pointe Drive, Lexington, SC 29072, USA.
| | - Edward Haupt
- Mayo Clinic Florida,1515 Sw Archer Rd, Gainesville, FL 32608, USA
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Hall S, Kaplan JRM, Schipper ON, Vulcano E, Johnson AH, Jackson JB, Aiyer AA, Gonzalez TA. Minimally Invasive Approaches to Haglund's Deformity and Insertional Achilles Tendinopathy: A Contemporary Review. Foot Ankle Int 2024; 45:664-675. [PMID: 38647216 PMCID: PMC11165941 DOI: 10.1177/10711007241237529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- SarahRose Hall
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | | | | | - Ettore Vulcano
- Department of Orthopaedic Surgery, Columbia University Mount Sinai Medical Center, Miami Beach, FL, USA
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Bakaes Y, Hall S, Jackson JB, Johnson AH, Schipper ON, Vulcano E, Kaplan JRM, Gonzalez TA. Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241320. [PMID: 38617581 PMCID: PMC11015789 DOI: 10.1177/24730114241241320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Background Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
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Affiliation(s)
- Yianni Bakaes
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - SarahRose Hall
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - J. Benjamin Jackson
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
| | | | | | - Ettore Vulcano
- Columbia University Division of Orthopedics at Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Tyler A. Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
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Karaismailoglu B, Altun AS, Subasi O, Sharma S, Peiffer M, Ashkani-Esfahani S, DiGiovanni CW, Bejarano-Pineda L. Comparison between achilles tendon reinsertion and dorsal closing wedge calcaneal osteotomy for the treatment of insertional achilles tendinopathy: A meta-analysis. Foot Ankle Surg 2024; 30:92-98. [PMID: 37838530 DOI: 10.1016/j.fas.2023.09.010] [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: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
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.
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Affiliation(s)
- Bedri Karaismailoglu
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey; CAST (Cerrahpasa Research, Simulation and Design Laboratory), Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ayse Sena Altun
- Bezmi Alem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Omer Subasi
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Siddhartha Sharma
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Matthias Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
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Moran C, Tourné Y. Posterior Heel Pain in Cavovarus Foot: How to Approach It. Foot Ankle Clin 2023; 28:775-789. [PMID: 37863534 DOI: 10.1016/j.fcl.2023.06.001] [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: 10/22/2023]
Abstract
When a patient presents with posterior heel pain on the background of a cavovarus foot, there are many different aspects to take into account. The morphology of the foot and the specific cause of the patient's pain lead the practitioner to alter the treatment appropriately. Some patients should only receive physiotherapy, but the majority should receive more invasive treatments, including calcaneal osteotomies or tendon debridement, depending on their particular presentation and pathology. This review examines the various different facets of posterior heel pain that must be dealt with and the most up-to-date treatments for the same.
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Affiliation(s)
- Conor Moran
- Centre Osteo Articulaires des Cèdres, 5 Rue des Tropiques Echirolles 38130, France
| | - Yves Tourné
- Centre Osteo Articulaires des Cèdres, 5 Rue des Tropiques Echirolles 38130, France.
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Shitrit E, Valentin E, Baudrier N, Bohu Y, Rauline G, Lopes R, Bauer T, Hardy A. The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4961-4968. [PMID: 37612477 PMCID: PMC10598148 DOI: 10.1007/s00167-023-07548-z] [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: 02/12/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport. The goal of this study was to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair. METHODS The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires. RESULTS A total of 50 patients were included. The ALR-RSI score was strongly (r > 0.5) correlated to the EFAS score: r = 0.68 [0.50-0.80] the FAMM sport score: r = 0.7 [0.52-0.84] the FAAM AVQ score (r = 0.6 [0.35-0.78]), and the VISA-A score (r = 0.54 [0.26-0.76]). The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40-81.4) compared to those that did: 83.2 (64.3-100) p = 0.001. Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097-1.00]. The internal consistency was excellent (alpha coefficient = 0.95). CONCLUSION The ALR-RSI score provides a valid, reproducible assessment of the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E Shitrit
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - E Valentin
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - N Baudrier
- Clinique Jouvenet, 6 Sq. Jouvenet, 75016, Paris, France
| | - Y Bohu
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - G Rauline
- , 34 Rue Michal, 75013, Paris, France
| | - R Lopes
- chirurgie orthopedique, Pied cheville Nantes Atlantique, sante Atlantique, avenue Claude-Bernard, 44800, Saint-Herblain, France
- Clinique Brétéché, 3, rue de la Béraudière, BP 54613, 44046, Nantes Cedex 1, France
| | - T Bauer
- Service de chirurgie orthopedique et traumatologique, hopital Ambroise Paré, universite Paris-Saclay, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - A Hardy
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France.
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9
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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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10
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Poutoglidou F, Drummond I, Patel A, Malagelada F, Jeyaseelan L, Parker L. Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis. Foot Ankle Surg 2023; 29:298-305. [PMID: 37088671 DOI: 10.1016/j.fas.2023.04.007] [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: 01/20/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with Insertional Achilles Tendinopathy (IAT) that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT. METHODS PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95 % confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). RESULTS Ten studies with 232 patients were included. Functional scores and pain levels were significantly improved after the Zadek osteotomy (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia. CONCLUSIONS The Zadek osteotomy is a safe and effective procedure for patients with IAT. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Freideriki Poutoglidou
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Isabella Drummond
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Amit Patel
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Francesc Malagelada
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Luckshmana Jeyaseelan
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Lee Parker
- Barts Bone & Joint Health, The Royal London Hospital, Barts Health NHS Trust, London, UK
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11
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Phisitkul P, Mansur NSB, Netto CDC. Failed Surgery for Achilles Tendinopathy. Foot Ankle Clin 2022; 27:431-455. [PMID: 35680298 DOI: 10.1016/j.fcl.2021.11.027] [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: 02/02/2023]
Abstract
Treatments of Achilles tendinopathy continue to evolve. The body of literature is inadequate to provide a comprehensive guide to evaluation and treat failed surgeries. Issues related to failed surgical treatment may be divided into infection/wound issue, mechanical failure, and persistent pain. Awareness of the potential problems described in this article will allow surgeons to have a foundation in clinical assessment and making accurate diagnoses. Various surgical treatment options are available and should be executed carefully to treat individualized patient conditions.
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Affiliation(s)
- Phinit Phisitkul
- Tri-state Specialists, LLP, 2730 Pierce Street #300, Sioux City, IA 51104, USA.
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
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12
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Tang SC, Tu KC, Liao WJ, Hsu CT, Shih HT, Tung KK, Wu MH, Wang SP. Novel Radiographic Measurements for Operatively Treated Haglund’s Deformity. Tomography 2022; 8:284-292. [PMID: 35202188 PMCID: PMC8876397 DOI: 10.3390/tomography8010023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Haglund’s deformity, which is characterized by a bony prominence of the posterosuperior aspect of the calcaneus, causes posterior heel pain. To date, there is no standard radiographic parameter to diagnose symptomatic Haglund’s deformity. Herein, we proposed novel radiographic measurements to distinguish between patients with and without symptomatic Haglund’s deformity. Methods: We retrospectively evaluated ankle radiographs of 43 patients who underwent surgery for symptomatic Haglund’s deformity (Haglund group) and 41 healthy individuals (control group) free of heel complaints. Fowler–Phillip angle (FPA), Heneghan–Pavlov parallel pitch lines (PPL), Haglund’s deformity height, bump height, and bump-calcaneus ratio were measured and compared between the groups. Furthermore, the reliability and cut-off value of each parameter were validated via ICC and ROC curve analysis, respectively. Results: The bump height (p < 0.001) and the bump-calcaneus ratio (p < 0.001) showed significant differences between the control and Haglund groups, unlike FPA, PPL, and Haglund’s deformity height. ROC curve analysis revealed that the AUC of bump-calcaneus ratio was larger than that of bump height. The optimal threshold was 4 mm or higher for bump height and 7.5% or higher for bump-calcaneus ratio. The intra- and inter- observer ICCs were, respectively, 0.965 and 0.898 for bump height and 0.930 and 0.889 for bump-calcaneus ratio. Conclusions: This study proposes two novel radiographic parameters to identify operatively treated Haglund’s deformity, namely bump height and bump-calcaneus ratio. They are easy to measure and intuitive. Both of them are effective diagnostic parameters for Haglund’s deformity. Furthermore, bump-calcaneus ratio is more reliable diagnostic parameter than bump height.
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Affiliation(s)
- Shih-Chieh Tang
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
| | - Kao-Chang Tu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
| | - Wei-Jen Liao
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
| | - Chang-Te Hsu
- Department of Orthopaedics, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Han-Ting Shih
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
| | - Kuan-Kai Tung
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
| | - Min-Huan Wu
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung 40704, Taiwan;
- Bachelor of Science in Senior Wellness and Sport Science, Tunghai University, Taichung 40704, Taiwan
| | - Shun-Ping Wang
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-C.T.); (K.-C.T.); (W.-J.L.); (H.-T.S.); (K.-K.T.)
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung 40704, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 5101)
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