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Ma L, Chang L, Gong Y, Wang Y, Bian X, Hu C, Guo L, Chen W, Tang K. Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: A retrospective study. Foot Ankle Surg 2024; 30:432-439. [PMID: 38494414 DOI: 10.1016/j.fas.2024.03.002] [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: 01/03/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. METHODS A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. RESULTS Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018). CONCLUSION Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.
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Affiliation(s)
- Lin Ma
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Le Chang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Yan Gong
- Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing 400038, China
| | - Yunjiao Wang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Xuting Bian
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Chao Hu
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Lin Guo
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Wan Chen
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China.
| | - Kanglai Tang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China.
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Stumpner T, Recheis S, Gruber MS, Kindermann H, Mattausch D, Bock P, Pöchgraber P, Ortmaier R, Bischofreiter M. Achilles tendon debridement, calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and athletic performance in patients with insertional Achilles tendinopathy. Foot Ankle Surg 2024:S1268-7731(24)00118-8. [PMID: 38871492 DOI: 10.1016/j.fas.2024.05.014] [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: 01/18/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited. METHODS Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction. RESULTS The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %. CONCLUSION Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction. LEVEL OF EVIDENCE Level IV - retrospective case series.
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Affiliation(s)
- Thomas Stumpner
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria.
| | - Simon Recheis
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Michael S Gruber
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Harald Kindermann
- University of Applied Sciences Upper Austria, Roseggerstraße 15, 4600 Wels, Austria
| | - Dietmar Mattausch
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Peter Bock
- Orthopoint Vienna, Mariahilfer Str. 49, 1060 Vienna, Austria
| | - Paul Pöchgraber
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Bischofreiter
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria; Department of Orthopaedic and Trauma Surgery, Clinic Diakonissen Schladming, Salzburgerstraße 777, 8970 Schladming, Austria
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Nakajima K. Insertional Achilles tendinopathy: A radiographic cross-sectional comparison between symptomatic and asymptomatic heel of 71 patients. Eur J Radiol Open 2024; 12:100568. [PMID: 38765668 PMCID: PMC11101900 DOI: 10.1016/j.ejro.2024.100568] [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] [Received: 05/10/2023] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose This retrospective study aimed to investigate whether the standard radiographic indicators for Haglund's syndrome are applicable to insertional Achilles tendinopathy. Methods Patients who underwent surgery for insertional Achilles tendinopathy in one heel and experienced no pain in the other heel were enrolled in this study. Preoperative calibrated radiographs of the lateral view of the calcaneus were assessed using (1) calcaneal pitch angle, (2) Fowler-Phillip angle, (3) posterior calcaneal angle, (4) Chauveau-Liet angle, (5) X/Y ratio, (6) Haglund's deformity height, (7) Haglund's deformity peak angle, (8) calcification length, (9) calcification width, (10) parallel pitch test, and (11) presence of free body. The Wilcoxon signed rank test and McNemar's test were used for statistical analyses. Results Seventy-one patients (52 males; mean age, 57.2; mean body mass index, 27.1) were included. Mean values for each index in the symptomatic and asymptomatic heels were as follows, respectively: (1) 23.5, 23.0 (p = 0.30); (2) 58.9, 57.8 (p < 0.05); (3) 7.6, 9.2 (p < 0.05); (4) 15.8, 13.9 (p < 0.05); (5) 2.8, 2.8 (p = 0.87); (6) 5.4, 5.0 (p < 0.05); (7) 99.6, 99.0 (p = 0.44); (8) 10.5, 7.6 (p < 0.001); and (9) 5.1, 4.4 (p < 0.05). The sensitivity, specificity, and area under curve of significant indicators were as follows, respectively: (2) 0.78, 0.37, 0.55; (3) 0.45, 0.72, 0.58; (4) 0.63, 0.54, 0.57; (6) 0.45, 0.69, 0.59; (8) 0.48, 0.80, 0.66; and (9) 0.63, 0.54, 0.59. The presence of free body also showed a significant difference between both heels (p < 0.05). Conclusion Some radiographic indicators for Haglund's syndrome are applicable to the diagnosis of insertional Achilles tendinopathy. A comparison of the parameters of Haglund's syndrome with those of insertional Achilles tendinopathy may illuminate the etiology and pathology of insertional Achilles tendinopathy and lead to novel treatments.
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Affiliation(s)
- Kenichiro Nakajima
- Department of Orthopedic Surgery, Yashio Central General Hospital, Saitama, Japan
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Hörterer H, Oppelt S, Harrasser N, Gottschalk O, Böcker W, Polzer H, Walther M, Baumbach SF. Recurrence rates for surgically treated insertional Achilles tendinopathy. Arch Orthop Trauma Surg 2024; 144:1021-1027. [PMID: 38085325 PMCID: PMC10896813 DOI: 10.1007/s00402-023-05155-8] [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: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Insertional Achilles tendinopathy (IAT) is a challenge for every orthopedic surgeon. Although surgical intervention is difficult to avoid after frustrating conservative therapy, little is known about recurrence of this disorder. Therefore the aim of the study was to assess the recurrence rate after primary IAT surgery. MATERIALS AND METHODS The authors previous published cohort on primary IAT surgery was reanalyzed. Patients with a follow-up Foot and Function Index (FFI) at one year and final follow-up were included. IAT recurrence was defined as a FFI worsening between one year and final follow-up of > 6.5 points. General demographics, surgical details, complications, and the patient reported outcome (PROM) were assessed. RESULTS Out of 58 included patients (51 ± 14 years), 8 patients (14%) suffered IAT recurrence after an average of 50 ± 25 months. None of the assessed factors was predictive for an IAT recurrence. CONCLUSION IAT recurrence after primary surgery occurs in up to 14% of patients. LEVEL OF EVIDENCE 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 Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sonja Oppelt
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Norbert Harrasser
- Clinic of Orthopaedics, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Oliver Gottschalk
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
- Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
| | - Sebastian Felix Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
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Abstract
A retrospective review of consecutive patients diagnosed with insertional Achilles tendinopathy (IAT) was performed. Outcomes included Visual Analog Scale (VAS) pain scores, return to run rates, and return to military duty rates. Our data analysis included 113 patients; 58 (55%) patients required surgery. Mean duration of follow-up was 42 months (range, 12-143). Mean age at the time of surgery was 37.2 years (range, 21-54). VAS scores significantly improved from 5.4 at the preoperative visit to 2.9 at 24 months. There was no significant improvement in VAS scores after the 3-month postoperative visit. Mean return to run time was 9 months (range, 4.5-16). At 1 year, 80% (46/58) of patients returned to military duty. Complications requiring return to the operating room were observed in 6 patients (9%). The high rate of return to duty and significant improvement in pain scores demonstrate that the surgical management of IAT is a viable treatment option for patients who could not otherwise remain on active duty. With that said, the complication rate of 27% is high. Patients and providers should consider the risks, benefits, and duration of therapy during their shared decision-making process.Level of Evidence: Level IV.
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Affiliation(s)
| | | | - Paul M Ryan
- Tripler Army Medical Center, Honolulu, Hawaii
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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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7
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Nakajima K. Fluoroscopic and Endoscopic Calcaneal Exostosis Resection and Achilles Tendon Debridement for Insertional Achilles Tendinopathy: Surgical Techniques. Arthrosc Tech 2023; 12:e855-e860. [PMID: 37424662 PMCID: PMC10323694 DOI: 10.1016/j.eats.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
This Technical Note describes the minimally invasive surgical techniques for insertional Achilles tendinopathy: fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement. First, two portals are placed 1 cm proximal and distal to the exostosis on the lateral heel. Next, blunt dissection around the exostosis and exostosis resection is performed under fluoroscopic guidance. The remaining space after the exostosis resection is used as the working space for endoscopy. Finally, the degenerated Achilles tendon is debrided endoscopically.
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Affiliation(s)
- Kenichiro Nakajima
- Address correspondence to Kenichiro Nakajima, M.D., Department of Orthopedic Surgery, Yashio Central General Hospital, 845 Minamikawasaki, Yashio-shi, Saitama 340-0814 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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Singh MS, Harna B, Singh S, Vishwakarma G. Evaluation of Flexor hallucis tendon transfer in chronic insertional Achilles tendinopathy in over 50-year-old population using validated ankle scores. Foot (Edinb) 2023; 54:101969. [PMID: 36805957 DOI: 10.1016/j.foot.2023.101969] [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: 09/15/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Chronic insertional Achilles tendinopathy is a common pathology in the over 50 years old population. Patients not relieved with conservative treatment had to undergo surgical intervention for the management. This study evaluates the clinical outcome of FHL transfer in such patients using validated ankle functional scores. METHOD It is a retrospective study including 20 patients of either gender managed with debridement of the distal degenerative remnant Achilles tendon fibers either at the insertion site or the distal end of the torn tendon, resection of Haglund deformity with FHL transfer, and reattachment of Achilles tendon. The average age of the patients was 56.55 + 11 years (50-77 years) followed by over 35.6 months (Range 22-48months). The preoperative FAAM, FADI, SF 36, VAS, and AOFAS scores were calculated and followed every 6 months. The plantarflexion and dorsiflexion of the ankle were also recorded preoperatively and at follow-up visits. RESULTS All the patients were operated on by a single surgeon (MS) with the same surgical technique, implant, and rehabilitation protocol. All the patients were followed for an average of 35.6 months (Range 22-48 months). All the ankle scores, FAAM, FADI, SF36, VAS, and AOFAS improved in follow-ups. The mean plantarflexion and dorsiflexion were 39.300+ 4.90 and 12.50+ 4.70 respectively. Three patients had minor wound complications. All the patients returned to activities of daily living. CONCLUSION FHL transfer in elderly patients with insertional Achilles tendinopathy improves the validated ankle functional scores and decreases pain significantly. Furthermore, randomized studies with a larger study population and longer follow-ups may ascertain the beneficial effects.
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Affiliation(s)
- Maninder S Singh
- Department of Orthopaedics, Indian Spinal Injuries Centre, New Delhi, India
| | - Bushu Harna
- Department of Orthopaedics, Max Super speciality Hospital, New Delhi, India.
| | - Sukhmin Singh
- Department of Orthopedics, Gautam Buddha Chikitsa Mahavidyalaya, Dehradun, Uttarakhand, India
| | - Gyatri Vishwakarma
- Department of Biostatistics, Indian Spinal Injuries Centre, New Delhi, India
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Cross AG, Khalil LS, Tomlinson M, Tramer JS, Makhni EC, Cox BA. Percutaneous Achilles Tendon Repair Using Ultrasound Guidance: An Intraoperative Ultrasound Technique. Arthrosc Tech 2023; 12:e173-e180. [PMID: 36879876 PMCID: PMC9984726 DOI: 10.1016/j.eats.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/12/2022] [Indexed: 01/21/2023] Open
Abstract
Rupture of the Achilles tendon is a common injury seen in patients of varying ages and activity levels. There are many considerations for treatment of these injuries, with both operative and nonoperative management providing satisfactory outcomes in the literature. The decision to proceed with surgical intervention should be individualized for each patient, including the patient's age, future athletic goals, and comorbidities. Recently, a minimally invasive percutaneous approach to repair the Achilles tendon has been proposed as an equivalent alternative to the traditional open repair, while avoiding wound complications associated with larger incisions. However, many surgeons have been hesitant to adopt these approaches due to poor visualization, concern that suture capture in the tendon is not as robust, and the potential for iatrogenic sural nerve injury. The purpose of this Technical Note is to describe a technique using high-resolution ultrasound guidance intraoperatively during minimally invasive repair of the Achilles tendon. This technique minimizes the drawbacks of poor visualization associated with percutaneous repair, while providing the benefit of a minimally invasive approach.
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Affiliation(s)
- Austin G Cross
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
| | - Lafi S Khalil
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Maggie Tomlinson
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
| | - Joseph S Tramer
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Benjamin A Cox
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
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Nakajima K. Fluoroscopic and Endoscopic Calcaneal Exostosis Resection and Achilles Tendon Debridement for Insertional Achilles Tendinopathy Results in Good Outcomes, Early Return to Sports Activities, and Few Wound Complications. Arthrosc Sports Med Rehabil 2022; 4:e1385-e1395. [PMID: 36033171 PMCID: PMC9402468 DOI: 10.1016/j.asmr.2022.04.027] [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] [Received: 09/17/2021] [Accepted: 04/24/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To review the outcomes of patients with insertional Achilles tendinopathy who underwent a minimally invasive surgery: fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement. Methods The medical records of consecutive patients who underwent this surgery from February 2017 to July 2019 were reviewed. The inclusion criterion was ≥2-year follow-up. The exclusion criterion was another surgery performed on the ipsilateral or contralateral foot. Haglund deformity resection was not combined with this surgery. The outcomes were assessed using the visual analog scale (VAS) score and the Japanese Society for Surgery of the Foot (JSSF) scores for all patients and the Victorian Institute of Sport Assessment self-administered Achilles (VISA-A) scores for patients participating in sports activities. The Wilcoxon signed-rank test and the thresholds of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were used for statistical analyses. Results Forty-four patients with a mean age of 55.7 ± 11.0 years and mean body mass index of 26.0 ± 4.0 kg/m2 were included. The mean follow-up duration was 2.8 ± 0.7 years. Of all participants, 22 participated in sports activities. The overall median VAS and JSSF scores improved from 64.5 to 6.5 mm and from 67.0 to 100 points, respectively (P < .001). The percentages of patients who achieved the MCID for the VAS, JSSF, and VISA-A scores were 100%, 93.2%, and 100%, respectively, and the percentages of patients who achieved the PASS for the VAS, JSSF, and VISA-A scores were 77.3%, 86.4%, and 81.8%, respectively. The median VISA-A scores improved from 40.5 to 95.0 points (P < .001). The median time to return to sport was 4.5 months. Complications included five cases of reoperation and two cases of scar sensitivity. Conclusion For patients with insertional Achilles tendinopathy, fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement resulted in good outcomes, early return to sports activities, and few wound complications. Level of Evidence IV, therapeutic case series
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12
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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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13
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Augmentation of suture anchors with magnesium phosphate cement – Simple technique with striking effect. J Mech Behav Biomed Mater 2022; 128:105096. [DOI: 10.1016/j.jmbbm.2022.105096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/20/2022]
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14
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Tourne Y, Baray AL, Barthelemy R, Karhao T, Moroney P. The Zadek calcaneal osteotomy in Haglund's syndrome of the heel: Clinical results and a radiographic analysis to explain its efficacy. Foot Ankle Surg 2022; 28:79-87. [PMID: 33658170 DOI: 10.1016/j.fas.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 02/04/2023]
Abstract
Local debridement or decompression of the posterior heel in Haglund's syndrome yields variable results. This condition is sometimes due to an excessively long calcaneus rather than simply a large posterosuperior bony prominence. Failure to address this abnormality may explain the poor results in some series. We recently published a new measurement (the X/Y ratio) which, combined with the calcaneal pitch angle, assesses the abnormality of the shape of the calcaneus. The Zadek osteotomy strongly modifies that shape. We retrospectively reviewed 50 patients treated by a Zadek osteotomy at a mean 7 years follow-up using the AOFAS ankle-hindfoot score, the VISA-A score and Tegner scale. We measured only the X/Y ratio and the calcaneal inclination angle, as the classically described radiographic measurements in Haglund's syndrome are unreliable. We then assessed the condition of the distal end of the Achilles tendon with an MRI. Our results demonstrate excellent outcomes(40/50, 80%) following Zadek osteotomy and correspond to the change in pre- and post-operative measurements, especially the X/Y ratio. An algorithm using those geometrical measurements of the calcaneus is proposed for decision making in Haglund's syndrome. Level of clinical evidence: Level 3.
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Affiliation(s)
- Yves Tourne
- Centre Ostéo-articulaire des Cèdres-Echirolles, France.
| | | | | | | | - Paul Moroney
- Sports Surgery Clinic, Santry, Dublin 9, Ireland.
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15
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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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16
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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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17
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De Cock L, Van Eynde E, Vandeputte G. Clinical results of distal anterior tibial tendon decompression. Foot Ankle Surg 2021; 27:827-831. [PMID: 33189545 DOI: 10.1016/j.fas.2020.10.012] [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: 08/30/2020] [Accepted: 10/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distal tibialis anterior tendinopathy (DTAT) is condition which is infrequently described in literature and is usually treated with conservative means. If resistant to a rehabilitation protocol and unloading, a surgical treatment could be proposed. The aim of this research is to report on the history and clinical image of DTAT and present the clinical results of a simple surgical decompression of the tendon with local debridement and release of the distal extensor retinaculum. METHODS Seventeen patients diagnosed with DTAT in 18 feet underwent surgery between 2008 and 2018. Upon initial presentation, all patients reported a persistent history of pain over the tibialis anterior (TA) insertion. Ultrasound was routinely performed to confirm the diagnosis. In patients with confirmed diagnosis of DTAT, persistent despite conservative treatment, we proceeded with surgical intervention during which we released the tendon by opening the distal extensor retinaculum. Retrospective chart review was performed, and functional outcomes were assessed using the AOFAS midfoot score. AOFAS score results were collected postoperatively with at least one-year follow-up. RESULTS All patients experienced pain on palpation of the distal aspect of the TA tendon. Most patients experienced pain at night and were frequent hikers. Our study population consisted of mostly female and overweight patients. All patients reported pain relief with a significant improvement of VAS for pain from 6.7 ± 1.1 preoperatively to 1.1 ± 1.2 postoperatively (p < 0.05). The postoperative AOFAS midfoot score was 97 ± 3.7. Fifteen patients were completely satisfied, two satisfied with minor reservations. CONCLUSION Simple distal TA tendon release by division of a consistently present constricting distal extensor retinaculum represents a surgical alternative in the treatment of chronic DTAT. Our study shows good clinical outcomes with low complications. LEVEL OF EVIDENCE Level IV - retrospective case series.
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Affiliation(s)
- Laurens De Cock
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200 Dendermonde, Belgium.
| | - Elke Van Eynde
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, GZA hospital, Sint-Vincentiusstraat 20, 2018 Anwerp, Belgium
| | - Geoffroy Vandeputte
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Heilig Hart hospital, Mechelsestraat 24, 2500 Lier, Belgium
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18
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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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19
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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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20
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Grambart ST, Lechner J, Wentz J. Differentiating Achilles Insertional Calcific Tendinosis and Haglund's Deformity. Clin Podiatr Med Surg 2021; 38:165-181. [PMID: 33745649 DOI: 10.1016/j.cpm.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Calcification of the posterior portion of the calcaneus has numerous terms that refer to this pathology. Given the number of names, there can be confusion when discussing the different pathologies involving calcification at the insertion of the Achilles tendon at the calcaneus. Two of the diagnosis that can be confused with each other are Haglund's deformity and Achilles insertional calcific tendinosis. This article discusses how these 2 entities are differentiated clinically and how their surgical management is different.
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Affiliation(s)
- Sean T Grambart
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA; Unitypoint Health - Iowa Methodist Medical Center, Des Moines, IA, USA.
| | - Jay Lechner
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Jennifer Wentz
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
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21
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Nuss CA, Huegel J, Finkielsztein S, Soslowsky LJ. Liquid Poly-N-acetyl Glucosamine (sNAG) Improves Achilles Tendon Healing in a Rat Model. Ann Biomed Eng 2021; 49:515-522. [PMID: 33409852 PMCID: PMC8178587 DOI: 10.1007/s10439-020-02711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
The Achilles tendon, while the strongest and largest tendon in the body, is frequently injured. Even after surgical repair, patients risk re-rupture and long-term deficits in function. Poly-N-acetyl glucosamine (sNAG) polymer has been shown to increase the rate of healing of venous leg ulcers, and use of this material improved tendon-to-bone healing in a rat model of rotator cuff injury. Therefore, the purpose of this study was to investigate the healing properties of liquid sNAG polymer suspension in a rat partial Achilles tear model. We hypothesized that repeated sNAG injections throughout healing would improve Achilles tendon healing as measured by improved mechanical properties and cellular morphology compared to controls. Results demonstrate that sNAG has a positive effect on rat Achilles tendon healing at three weeks after a full thickness, partial width injury. sNAG treatment led to increased quasistatic tendon stiffness, and increased tangent and secant stiffness throughout fatigue cycling protocols. Increased dynamic modulus also suggests improved viscoelastic properties with sNAG treatment. No differences were identified in histological properties. Importantly, use of this material did not have any negative effects on any measured parameter. These results support further study of this material as a minimally invasive treatment modality for tendon healing.
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Affiliation(s)
- Courtney A Nuss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA
| | - Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA
| | - Sergio Finkielsztein
- Marine Polymer Technologies, Inc., 1 Van De Graaff Drive, Suite 302, Burlington, MA, 01803, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA, 19104-6081, USA.
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22
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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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23
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Zheng W, Liu P, Liang X, Zhao H. [Research progress in Achilles tendinopathy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1619-1623. [PMID: 33319546 DOI: 10.7507/1002-1892.202002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the classification, diagnosis, and clinical treatment of Achilles tendinopathy. Methods The literature about Achilles tendinopathy at home and abroad was reviewed. The research results of classification and terms, imaging diagnosis, and clinical treatment of Achilles tendinopathy were summarized. Results The classification and name of Achilles tendinopathy are not completely unified, and the concept is vague, the cause of disease is not clear. There are many treatment plans, but there is no effective evidence-based medicine research. Conclusion The diagnosis and treatment of Achilles tendinopathy is complicated. According to the characteristics of Achilles tendon anatomy and etiology, the classification and definition of Achilles tendinopathy need to be further studied in order to guide clinical treatment more effectively and facilitate experience exchange and learning.
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Affiliation(s)
- Weixin Zheng
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Peilong Liu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hongmou Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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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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26
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Influence of Badminton Practice on Age-Related Changes in Patellar and Achilles Tendons. J Aging Phys Act 2020; 29:382-390. [PMID: 33049699 DOI: 10.1123/japa.2020-0215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
Regular sport practice could prevent age-related changes in tendinous tissues. The purpose of the study was to investigate the effect of regular badminton practice on patellar and Achilles tendon mechanical properties in senior competitive badminton players (>35 years old) and to compare the results with physically active people matched by age. One hundred ninety-two badminton players and 193 physically active people were divided by age into four groups, between 35 and 44 (U45), between 45 and 54 (U55), between 55 and 64 (U65), and over 65 (O65) years old. A LogiqS8 transducer in elastography mode and a MyotonPRO myotonometer were used to assess patellar and Achilles mechanical properties. Achilles tendon stiffness was higher in the control group than the badminton players for the U45, U55, and O65 age groups (p < .01). Also, the elastography index was higher in the control group than the badminton players for the U45, U55, U65, and O65 age groups (p < .05). In conclusion, regular badminton practice could prevent the decline in mechanical properties of the patellar and Achilles tendons.
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Sederberg M, Cushman DM. Current Treatments of Insertional Achilles Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5319640. [PMID: 32149113 PMCID: PMC7049442 DOI: 10.1155/2020/5319640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/12/2019] [Accepted: 01/25/2020] [Indexed: 12/26/2022]
Abstract
Background Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. Methods The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author's hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. Results In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P < 0.05). Conclusion There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.
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