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Fradet J, Lopes R. Endoscopic calcaneal SpeedBridge technique: Decreased postoperative complication rate in insertional achilles tendinopathy. Orthop Traumatol Surg Res 2024; 110:103916. [PMID: 38885739 DOI: 10.1016/j.otsr.2024.103916] [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: 12/02/2021] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 06/20/2024]
Abstract
BACKGROUND An endoscopic calcaneal SpeedBridge technique was described recently. The primary objective of this study was to report the postoperative complications seen with calcaneal SpeedBridge repair. The secondary objective was to report short- and medium-term functional outcomes. HYPOTHESIS Postoperative complications are less common with endoscopic vs. open SpeedBridge suturing. MATERIAL AND METHODS The endoscopic SpeedBridge technique was used in 9 patients who had insertional Achilles tendinopathy refractory to conservative management. The patients were evaluated at least 24 months after the procedure. Infectious and wound-healing complications were recorded. Visual analogue scale (VAS) scores for pain and patient satisfaction, shoeing difficulties, the European Foot and Ankle Society (EFAS) score, and the Victorian Institute of Sport Assessment-Achilles (VISA-A) score were assessed. RESULTS During the mean follow-up of 25.3 months, no complications were recorded. The EFAS and VISA-A scores were 37/40 and 91/100, respectively. The mean VAS scores for pain and satisfaction were 1.7/10 and 9.3/10, respectively. No patients reported shoeing difficulties. CONCLUSION Endoscopic calcaneal SpeedBridge suturing is associated with a lower complication rate compared to the open variant. Clinical outcomes are highly satisfactory in the short and middle terms. LEVEL OF EVIDENCE IV; retrospective observational cohort study.
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Affiliation(s)
- Juliette Fradet
- Pied cheville Nantes Atlantique, Santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France; Polyclinique de Poitiers (ELSAN), 1, rue de la Providence, 86000 Poitiers, France.
| | - Ronny Lopes
- Clinique Brétéché, 3, rue de la Béraudière, BP 54613, 44046 Nantes cedex 1, France; Centre orthopédique Santy, unité cheville pied, 359, avenue Jean Jaurès, 69007 Lyon, France
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2
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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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3
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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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4
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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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5
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Rocha J, Araújo JC, Fangueiro R, Ferreira DP. Wetspun Polymeric Fibrous Systems as Potential Scaffolds for Tendon and Ligament Repair, Healing and Regeneration. Pharmaceutics 2022; 14:2526. [PMID: 36432717 PMCID: PMC9699541 DOI: 10.3390/pharmaceutics14112526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Tendon and ligament traumatic injuries are among the most common diagnosed musculoskeletal problems. Such injuries limit joint mobility, reduce musculoskeletal performance, and most importantly, lower people's comfort. Currently, there are various treatments that are used to treat this type of injury, from surgical to conservative treatments. However, they're not entirely effective, as reinjures are frequent and, in some cases, fail to re-establish the lost functionality. Tissue engineering (TE) approaches aim to overcome these disadvantages by stimulating the regeneration and formation of artificial structures that resemble the original tissue. Fabrication and design of artificial fibrous scaffolds with tailored mechanical properties are crucial for restoring the mechanical function of the tissues. Recently, polymeric nanofibers produced by wetspinning have been largely investigated to mimic, repair, and replace the damaged tissue. Wetspun fibrous structures are extensively used due to their exceptional properties, such as the ability to mimic the native tissue, their biodegradability and biocompatibility, and good mechanical properties. In this review, the tendon and ligament structure and biomechanics are presented. Then, promising wetspun multifunctional fibrous structures based on biopolymers, more specifically polyhydroxyalkanoates (PHA), polycaprolactone (PCL), and polyethylenes, will be discussed, as well as reinforcing agents such as cellulose nanocrystals (CNC), nanoparticles, and growth factors.
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Affiliation(s)
- Joana Rocha
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800 Guimarães, Portugal
| | - Joana C Araújo
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800 Guimarães, Portugal
| | - Raul Fangueiro
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800 Guimarães, Portugal
| | - Diana P Ferreira
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800 Guimarães, Portugal
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6
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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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7
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Madi S, Hillrichs B. Haglund's Deformity as a Cause of Acute Achilles Tendon Rupture: A Case Report. J Foot Ankle Surg 2022; 61:410-413. [PMID: 34961680 DOI: 10.1053/j.jfas.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 10/06/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
Achilles tendon rupture is a common problem affecting both high level and casual athletes. Haglund´s deformity is an abnormality of the postero-superior part of the calcaneus, which often leads to retro-calcaneal bursitis as well as thickening and inflammation of the calcaneal tendon, a combination of pathologies known as Haglund's syndrome. We report a rare case of a relapse Achilles tendon rupture in a 39-year-old professional handball player with a pronounced painful Haglund´s deformity treated with tendon debridement and reattachment using the Arthrex Speedbridge® system. This case report illustrates a rarely described operative and post-operative management of this unusual combination of Achilles tendon rupture and Haglund´s deformity.
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Affiliation(s)
- Saad Madi
- Resident, Department of Traumatology and Orthopedics, Muehlenkreiskliniken, Luebbecke, Germany
| | - Bernd Hillrichs
- Chief, Department of Traumatology and Orthopedics, Muehlenkreiskliniken, Luebbecke, Germany.
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8
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Wolf J, Fallat L, Coffey M. Outcomes and Material Cost Comparison of Transosseous Versus Suture Anchor Fixation of the Achilles Tendon: A Retrospective Study. J Foot Ankle Surg 2022; 61:12-16. [PMID: 34247969 DOI: 10.1053/j.jfas.2021.05.012] [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: 10/06/2020] [Revised: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 02/03/2023]
Abstract
Insertional Achilles tendinopathy is a common pathology that may be resistant to conservative treatment requiring surgical intervention. Treatment often involves partial to complete detachment of the Achilles tendon, debridement, and reattachment. Although 50% of the tendon may be safely resected without significantly compromising strength, the addition of a lengthening procedure requires further reinforcement. We conducted a retrospective review of 43 procedures comparing outcomes of 16 single suture anchor procedures with 27 transosseous fixation procedures for reattachment of the Achilles. The suture anchor group utilized one of 2 different industry anchors while the transosseous group utilized sutures ranging in size from 2-0 to #2. Female patients contributed 67% of the procedures with 53% occurring on the left side. For each group the median preoperative pain score (scale 0-10) was 8 and the median of the lowest reported postoperative pain score was 0. The typical time to lowest postoperative pain was 10 weeks for the suture anchor group and 4 weeks for the transosseous group. Tourniquet time averaged 59.3 (12.9) minutes for the suture anchor group and 65.1 (16.4) for the transosseous group. There was a large difference in material costs between the suture anchor and transosseous groups which ranged from $364.51 to $448.51 and $99.80 to $104.00 respectively. With similar results on postoperative pain and adverse event rate to suture anchor fixation and lower material costs than anchor fixation, transosseous fixation remains a viable option for fixating the Achilles tendon to bone in treatment of insertional Achilles tendinopathy.
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Affiliation(s)
- Joseph Wolf
- Resident Submitted During Postgraduate Year 3, Podiatric Foot and Ankle Residency Beaumont Hospital Wayne, Wayne, MI.
| | - Lawrence Fallat
- Director, Podiatric Foot and Ankle Residency, Beaumont Hospital Wayne, Wayne, MI
| | - Mary Coffey
- Senior Biostatistician, Beaumont Research Institute, Royal Oak, MI
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9
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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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10
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Hörterer H, Oppelt S, Böcker W, Gottschalk O, Harrasser N, Walther M, Polzer H, Baumbach SF. Patient-Reported Outcomes of Surgically Treated Insertional Achilles Tendinopathy. Foot Ankle Int 2021; 42:1565-1569. [PMID: 34154453 DOI: 10.1177/10711007211023060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the patient-reported outcome measures (PROMs) in patients with insertional Achilles tendinopathy (IAT) treated surgically by debridement of all pathologies through a midline-incision trans-achillary approach (MITA). METHODS This is a retrospective cohort study with current follow-up. Patients treated surgically by a MITA, addressing all pathologies of IAT, with at least 12 months of follow-up were included. Demographics, medical history, surgical details, and complications were recorded. Patient-reported outcomes were assessed using the Foot Function Index (FFI), Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-G), visual analog scale foot and ankle (VAS-FA), and 12-Item Short-Form Health Survey (SF-12). Longitudinal FFI data were available for 48% of the patients. RESULTS A total of 118 patients (63.4%) with a mean follow-up of 50 ± 25 months were included. The FFI improved from 53 (24) preoperatively to 2 (11) points at the final follow-up. The final VISA-A-G score was 93 (26), the VAS-FA score 93 (15), the SF-12 Physical Component Summary 56 (8), and the SF-12 Mental Component Summary 55 (12) points. There was an additional FFI improvement between 12 months and the final follow-up. Up to 47% (VISA-A-G) of patients had residual symptoms. A postoperative shoe conflict was the only parameter negatively affecting the PROMs (P < .001). CONCLUSION Addressing all pathologies of IAT by the MITA resulted in overall good postoperative PROMs after 4 years. But up to 47% of patients remained impaired. The only parameter correlating with an impaired PROM was a postoperative shoe conflict. 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, Bavaria, Germany.,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
| | - Oliver Gottschalk
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Bavaria, Germany.,Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Bavaria, Germany.,Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
| | - Hans Polzer
- 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
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11
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Abate M, Di Carlo L, Salini V. To evaluate the outcomes of PRP treatment in Achilles tendinopathy: An intriguing methodological problem. Orthop Traumatol Surg Res 2021; 107:102787. [PMID: 33333266 DOI: 10.1016/j.otsr.2020.102787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/03/2019] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Assessing the outcomes of Platelet Rich Plasma (PRP) treatment in Achilles Tendinopathy (AT) may prove difficult due to several methodological reasons. For example, given that the simple mean of VISA-A score is just the result of positive, negative or null values, this may provide incomplete information, and therefore the size of individual changes can remain unknown. On the contrary, calculating the score changes in each subject after treatment would allow a more appropriate evaluation of the clinical results. However, this method has been applied only to few small-scale studies. Therefore we performed a retrospective study aiming to determine: (1) are the percentages of positive outcomes of the present research comparable to those of previous studies performed in different settings? (2) Is there a relationship between the size of increase of the clinical score and the patient satisfaction? HYPOTHESES The percentages of positive outcomes of the present research are comparable to those of previous studies performed in different settings. MATERIAL AND METHODS This is a retrospective observational study. Eighty-four patients submitted to PRP treatment for mid-portion AT were enrolled. Pain and function were evaluated by means of VISA-A scale. Besides the mean, in each subject the pre- and post-treatment difference of VISA-A score was computed and the outcome was defined clinically no detectable, detectable and evident according to the increasing values of the score (0 to 9 points, 10 to 19, and≥20 points change, respectively). The Likert's scale for the patients satisfaction was also used. RESULTS The mean VISA-A increased significantly after treatment (from 50.1±9.1 at baseline to 63.7±13.8 at 3 months (p=0.00001) and 67.2±14.1 at 6 months (p=0.00001)). At 3 and 6 months the subjects belonging to the prefixed categories were 15, 45, 24 and 19, 36, 29, respectively. Moreover, large discrepancies were observed between the size of increase of the clinical score and patients satisfaction, mainly for intermediate increases of the score. DISCUSSION The percentages of positive outcomes found in this study are slightly lower than those reported in literature. The different patients expectations about the efficacy of the therapy can explain the discrepancies between the size of increase of the clinical score and the individual satisfaction. In comparison to the simple mean, the individual changes of VISA-A score allow a proper evaluation of the outcomes. The research shows that discrepancies can be present in the percentage of positive clinical outcomes between different studies. The size of increase of the clinical score does not always match patient satisfaction. LEVEL OF PROOF IV retrospective study without control group.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Sciences of Aging, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini 31, 66013, Chieti Scalo (CH), Italy.
| | - Luigi Di Carlo
- Department of Medicine and Sciences of Aging, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini 31, 66013, Chieti Scalo (CH), Italy
| | - Vincenzo Salini
- Division of Orthopedics and Traumatology, San Raffaele Hospital, Milan, Italy
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12
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Laumonerie P, Mattesi L, Patrick C, Tibbo ME, Ancelin D. Endoscopic resection of enthesopathy via a direct midline transtendinous approach with associated reattachment of the Achilles tendon (endo-REDMTART): a cadaveric feasibility study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1237-1245. [PMID: 34417896 DOI: 10.1007/s00590-021-03098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study was to determine the feasibility of an all-posterior endoscopic resection of enthesopathy via direct midline transtendinous approach with detachment and reattachment of the Achilles tendon (endo-REDMTART). MATERIALS & METHODS Endo-REDMTART was performed in 10 ankles by two foot and ankle surgeons. Posterolateral and posteromedial portals were utilized. Three accessory, more distal portals were utilized (one posterolateral, one posteromedial, and one midline transtendinous). We measured the quality of the resection of the calcaneal spur and the length of tendon that was able to be reattached to the calcaneus. RESULTS The procedure was successful in all 10 cases. The mean minimum thickness of resected calcaneal spur was 7 mm (5-9 mm) thick, and the mean anteroposterior distance was 23 mm (20-25 mm). In all 10 cases, the maximum distance between the distal Achilles tendon and calcaneus was 1 mm (0-1 mm), with good tendon-bone contact. CONCLUSIONS The data here suggest that endo-REDMTART is feasible. This procedure provides all of the advantages of endoscopic technique without compromising the efficacy of Haglund deformity resection. TRIAL REGISTRATION No Clinical Trials Registration or IRB is required. LEVEL OF EVIDENCE Anatomy study; cadaveric dissection.
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Affiliation(s)
- P Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pellegrin, Place Amélie Raba-léon, 33076, Bordeaux, France.
| | - L Mattesi
- I2R, Institut de Recherche Riquet, 31059, Toulouse, France.,Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
| | - Chaynes Patrick
- Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
| | - M E Tibbo
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - D Ancelin
- I2R, Institut de Recherche Riquet, 31059, Toulouse, France.,Anatomy Laboratory, Faculty of Medicine, 31062, Toulouse, France
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13
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Lopes R, Padiolleau G, Fradet J, Vieira TD. Endoscopic SpeedBridge Procedure for the Treatment for Insertional Achilles Tendinopathy: The Snake Technique. Arthrosc Tech 2021; 10:e2127-e2134. [PMID: 34504752 PMCID: PMC8417342 DOI: 10.1016/j.eats.2021.05.014] [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: 03/04/2021] [Accepted: 05/18/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical treatment of insertional Achilles tendinopathy is indicated in case of failure of conservative therapy. A choice is then made within a large spectrum of procedures from minimally invasive techniques such as endoscopic calcaneoplasty to more invasive procedures, such as dorsal closing wedge calcaneal osteotomy. Isolated calcaneoplasties can lead to poor results in cases of pre-existing Achilles tendon lesions; in these cases the tendon disinsertion is justified. In this context, we describe an endoscopic treatment of insertional Achilles tendinopathy.
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Affiliation(s)
- Ronny Lopes
- Pied Cheville Nantes Atlantique, Clinique Brétéché, Nantes, France,Pied Cheville Nantes Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Giovany Padiolleau
- Pied Cheville Nantes Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Juliette Fradet
- Pied Cheville Nantes Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France,Address correspondence to Thais Dutra Vieira, M.D., 24 Avenue Paul Santy, Lyon 69008 France.
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14
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Alessio-Mazzola M, Russo A, Capello AG, Lovisolo S, Repetto I, Formica M, Felli L. Endoscopic calcaneoplasty for the treatment of Haglund's deformity provides better clinical functional outcomes, lower complication rate, and shorter recovery time compared to open procedures: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2462-2484. [PMID: 33216187 DOI: 10.1007/s00167-020-06362-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this research is to report the clinical outcome following surgical correction of Haglund's deformity summarising different surgical strategies and comparing clinical outcomes, failures, complications and return to activities of patients underwent open and endoscopic techniques. METHODS A systematic search of the literature was conducted using eight different databases. Thirty-five studies were included in the systematic review. A total of 1260 ankles of 1147 patients were grouped in accordance with the surgical approach (open, endoscopic, or percutaneous). RESULTS The overall mean age was 44.8 ± 8.2 (range 14.9-82) years with a mean follow-up of 30.9 ± 17.1 (range 3-132) months. Analysis of clinical outcomes of open and endoscopic techniques demonstrated significant differences of AOFAS (87.1 ± 5.9 versus 90.7 ± 4.2 points; P < 0.001), complications (15.5% versus 4.1%; P < 0.001), failures (6.0% versus 1.2%; P < 0.001), time to return to daily activities (17.2 ± 9.3 versus 6.3 ± 1.0 weeks; P < 0.001) and time to return to sport (20.7 ± 3.3 versus 11.9 ± 0.3 weeks; P < 0.001) in the studies that reported these specific outcome measures. CONCLUSION Surgical correction of Haglund's deformity provides overall good clinical results and high subjective satisfaction. Endoscopic procedures demonstrated better final AOFAS, a lower rate of complications and failures, and shorter recovery time when compared to open techniques. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mattia Alessio-Mazzola
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genova, Italy. .,Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Antonio Russo
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Andrea Giorgio Capello
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Stefano Lovisolo
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Ilaria Repetto
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Matteo Formica
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genova, Italy.,Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Lamberto Felli
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genova, Italy.,Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
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15
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Lo Presti M, Costa GG, Agrò G, Vasco C, Zunarelli P, Zaffagnini S. Adipose-derived Stromal Vascular Fraction Injection in a Competitive High-level Athlete Affected by Insertional Achilles Tendinopathy. J Foot Ankle Surg 2021; 60:626-629. [PMID: 33551230 DOI: 10.1053/j.jfas.2020.04.019] [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: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is one of the most common ankle and foot overuse injuries, especially among athletes. Despite this, the management of this injury lacks an evidence-based support, and patients are at risk of long-term morbidity with unpredictable clinical outcome. Recently, injective approach has gained more and more attention, and in particular the intratendinous injection with adipose-derived stromal vascular fraction. We report a case of an insertional Achilles tendinopathy in a high-level professional athlete, who was treated avoiding surgical treatment in favor of this innovative biological approach. Patient's satisfaction and return to play was prospectively evaluated for a period of 6 months of follow-up. An improvement of all functional scores was yet appreciated after 1 month from the treatment, with a crescent trend until the last 6-month follow-up. The patient was able to return to train after 34 days, and returned to match after 68 days, playing 20 minutes. She returned to the complete full game 72 days after treatment. However subsequent ultrasound and MRI evaluations failed to show any substantial changes in the characteristics of the lesion from the preoperative images. This case report opens a new window for the treatment of insertional Achilles tendinopathy in competitive athletes. The current outcome deserves further investigation with higher quality studies in order to confirm the validity of this fascinating therapeutic option.
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Affiliation(s)
- Mirco Lo Presti
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Giuseppe Agrò
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cosimo Vasco
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pierpaolo Zunarelli
- Physician, Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Zaffagnini
- Physician and Full Professor, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Jarin IJ, Bäcker HC, Vosseller JT. Functional Outcomes of Insertional Achilles Tendinopathy Treatment: A Systematic Review. JBJS Rev 2021; 9:01874474-202106000-00008. [PMID: 34125735 DOI: 10.2106/jbjs.rvw.20.00110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Achilles tendinopathy is a common clinical problem that can be either insertional or noninsertional, and effective treatment of each type can vary. We sought to investigate the current evidence on different treatment methods for insertional Achilles tendinopathy with a focus on functional outcomes. METHODS We performed a systematic review of the available literature using the PubMed/MEDLINE and Cochrane Central Register of Controlled Trials databases. Data from included studies were categorized according to treatment method and reported with respect to functional outcomes and complications. RESULTS A total of 1,457 abstracts were reviewed; 54 studies with 2,177 patients met the inclusion criteria. Among the 54 studies, 6 operative techniques and 6 nonoperative treatments were evaluated. CONCLUSIONS Eccentric exercises and low-energy extracorporeal shockwave therapy (ESWT) have the greatest evidence for the initial management of insertional Achilles tendinopathy. ESWT has been increasingly studied in recent years, but more high-quality evidence is needed. Operative treatment with tenotomy, debridement, retrocalcaneal bursectomy, and calcaneal exostectomy is effective. Flexor hallucis longus tendon transfer may benefit cases of more severe disease. Minimally invasive procedures have a potential role in the treatment algorithm and require more rigorous study. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ian J Jarin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Henrik C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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17
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Ruiz-Alonso S, Lafuente-Merchan M, Ciriza J, Saenz-Del-Burgo L, Pedraz JL. Tendon tissue engineering: Cells, growth factors, scaffolds and production techniques. J Control Release 2021; 333:448-486. [PMID: 33811983 DOI: 10.1016/j.jconrel.2021.03.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023]
Abstract
Tendon injuries are a global health problem that affects millions of people annually. The properties of tendons make their natural rehabilitation a very complex and long-lasting process. Thanks to the development of the fields of biomaterials, bioengineering and cell biology, a new discipline has emerged, tissue engineering. Within this discipline, diverse approaches have been proposed. The obtained results turn out to be promising, as increasingly more complex and natural tendon-like structures are obtained. In this review, the nature of the tendon and the conventional treatments that have been applied so far are underlined. Then, a comparison between the different tendon tissue engineering approaches that have been proposed to date is made, focusing on each of the elements necessary to obtain the structures that allow adequate regeneration of the tendon: growth factors, cells, scaffolds and techniques for scaffold development. The analysis of all these aspects allows understanding, in a global way, the effect that each element used in the regeneration of the tendon has and, thus, clarify the possible future approaches by making new combinations of materials, designs, cells and bioactive molecules to achieve a personalized regeneration of a functional tendon.
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Affiliation(s)
- Sandra Ruiz-Alonso
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Markel Lafuente-Merchan
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Jesús Ciriza
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - Laura Saenz-Del-Burgo
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain.
| | - Jose Luis Pedraz
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain.
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18
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Zhang C, Cao J, Yang L, Duan X. Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up. J Int Med Res 2021; 49:300060521992959. [PMID: 33682490 PMCID: PMC7944541 DOI: 10.1177/0300060521992959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT). METHODS This retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores. RESULTS Thirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT. CONCLUSION Surgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.
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Affiliation(s)
- Changgui Zhang
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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19
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Lakey E, Kumparatana P, Moon DK, Morales J, Anderson SE, Baldini T, Pereira H, Hunt KJ. Biomechanical Comparison of All-Soft Suture Anchor Single-Row vs Double-Row Bridging Construct for Insertional Achilles Tendinopathy. Foot Ankle Int 2021; 42:215-223. [PMID: 33030070 DOI: 10.1177/1071100720959023] [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: 02/01/2023]
Abstract
BACKGROUND Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. METHODS Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. RESULTS The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. CONCLUSION This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. CLINICAL RELEVANCE Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.
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Affiliation(s)
- Eric Lakey
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Pam Kumparatana
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel K Moon
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph Morales
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Todd Baldini
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hélder Pereira
- Orthopedic Surgery Department, Centro Hospitalar Póvoa de Varzim-Vila do Conde, Unidade da Póvoa de Varzim, Póvoa de Varzim, Portugal
| | - Kenneth J Hunt
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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20
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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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21
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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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22
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Cusumano A, Martinelli N, Bianchi A, Bertelli A, Marangon A, Sansone V. Transtendinous approach calcaneoplasty versus endoscopic calcaneoplasty for Haglund's disease. INTERNATIONAL ORTHOPAEDICS 2020; 45:225-231. [PMID: 32767086 DOI: 10.1007/s00264-020-04761-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE In this study, we performed a comparison between open calcaneoplasty through transtendinous approach and endoscopic calcaneoplasty for Haglund's disease. METHODS A retrospective review was performed of patients who had undergone either a calcaneoplasty with transtendinous approach or endoscopic for Haglund's disease from three centres. Inclusion criteria were patients with Haglund's disease confirmed radiographically, neutral alignment of the hindfoot and at least one year of follow-up. Patients were excluded in case of ipsilateral ankle osteoarthritis or other neighbouring joints, previous foot surgery, hindfoot malalignment and marked calcific insertional Achilles tendinosis. A chart review was performed to collect demographic data, including age, sex and body mass index (BMI). Functional outcome analysis included the Foot Function Index, AOFAS score and VAS for pain pre-operatively and post-operatively at the last follow-up. This patient-reported outcome scores were used in the native language of each patient (Italian). RESULTS Clinical and functional outcomes were collected from 54 patients (28 heels treated by open technique and 26 heels treated by endoscopic technique). In the open group, the AOFAS score improved from a pre-operative value of 65.67 ± 10.09 points to a value of 91.78 ± 9.67 points at the last follow-up (P < 0.05). In the endoscopic group, the AOFAS score improved from a pre-operative value of 66.69 ± 7.19 points to a value of 93.69 points ± 10.04 at the last follow-up (P < 0.05). The VAS and the FFI (Disability and Pain) scores were also improved significantly in both groups at the final follow-up evaluation (P < 0.001). Comparing the final follow-up post-operative clinical scores between the two groups, there was no difference in the AOFAS, VAS or the FFI scores between the two groups. No major complications were recorded, except for one Achilles tendon tear after open calcaneoplasty. The satisfaction rate was similar for both techniques. CONCLUSIONS Both techniques provided good clinical outcomes with a low rate of complications.
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Affiliation(s)
- Andrea Cusumano
- Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy
| | - Nicolò Martinelli
- Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy.
| | - Alberto Bianchi
- Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy
| | | | | | - Valerio Sansone
- Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy
- Department of Orthopedics, University of Milan, Milan, Italy
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23
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Abstract
Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be defined to guide the rehabilitation of injured athletes.
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Affiliation(s)
- Jon-Michael E Caldwell
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH11-Center Wing, New York, NY 10032, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH11-Center Wing, New York, NY 10032, USA.
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24
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Zhuang Z, Yang Y, Chhantyal K, Chen J, Yuan G, Ni Y, Liu D, Shi D. Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4920647. [PMID: 31531355 PMCID: PMC6720369 DOI: 10.1155/2019/4920647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/13/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. METHODS 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. RESULTS No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. CONCLUSIONS Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.
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Affiliation(s)
- Ze Zhuang
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Yang Yang
- Departments of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Kishor Chhantyal
- Departments of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Jianning Chen
- Departments of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Guohui Yuan
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Yirong Ni
- MOE Key Laboratory of Laser Life Science & SATCM Third Grade Laboratory of Chinese Medicine and Photonics Technology, College of Biophotonics, South China Normal University, Guangzhou 510631, China
| | - Dezhao Liu
- Departments of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Dehai Shi
- Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
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25
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Tourné Y, Baray AL, Barthélémy R, Moroney P. Contribution of a new radiologic calcaneal measurement to the treatment decision tree in Haglund syndrome. Orthop Traumatol Surg Res 2018; 104:1215-1219. [PMID: 30391217 DOI: 10.1016/j.otsr.2018.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/03/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In Haglund syndrome, standard radiologic measurements lack specificity and reliability in assessing etiologic morphologic calcaneal abnormalities. We report a simple X/Y ratio to measure posterior calcaneal length, where X is calcaneal length on lateral weight-bearing view and Y is greater tuberosity length. OBJECTIVE To compare this new parameter against the radiologic gold standard in a group of Haglund patients and a healthy control group. HYPOTHESIS Measuring this ratio significantly distinguishes between Haglund patients and healthy subjects. MATERIAL AND METHODS A retrospective study included 50 Haglund syndrome patients and 30 healthy controls. Standard measurements (Fowler-Philipangle, Chauveaux-Liet angle, Ruch pitch, Heneghan-Pavlov test) and X/Y ratio were calculated twice by 2 independent observers. Intra- and inter-observer correlations were calculated, as were the specificity and sensitivity of the various parameters, with a ROC curve to establish the X/Y threshold. RESULTS All measurements were reproducible on intra- and inter-observer testing. There were no significant inter-group differences in standard measurement specificity or sensitivity. The Haglund group showed significantly lower X/Y ratio (2.07) than controls (2.70; p<0.0001), with a cut-off at 2.5. Threshold sensitivity in confirming Haglund syndrome was 100% (p<0.0001) and specificity 95% (p<0.0001). DISCUSSION This new parameter measures the length of the calcaneus and its greater tuberosity. It is more reliable and reproducible in terms of sensitivity and specificity than standard measurements in Haglund syndrome. The 2.5 ratio threshold can guide surgical decision-making. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yves Tourné
- Centre ostéo-articulaire des Cèdres-Échirolles, 5, rue des tropiques, 38130 Échirolles, France.
| | - Anne-Laure Baray
- Service de chirurgie orthopédique, CHU de Saint-Étienne, 42270 Saint-Priest en Jarez, France
| | | | - Paul Moroney
- Sports Surgery Clinic, Santry, Dublin 9, Ireland
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