A novel technique of minimally invasive calcaneal osteotomy for intractable insertional Achilles tendinopathy associated with Haglund deformity

2021 ◽  
Author(s):  
Jun Young Choi ◽  
Jin Soo Suh
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendinopathy ◽  
Novel Technique ◽  
Calcaneal Osteotomy ◽  
Haglund Deformity ◽  
Insertional Achilles Tendinopathy

scholarly journals Minimally invasive calcaneal osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0048
Author(s):  
Kar Teoh ◽  
Kartik Hariharan
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Average Length ◽  
Achilles Tendinopathy ◽  
Complication Rates ◽  
Union Rate ◽  
Average Length Of Stay ◽  
Calcaneal Osteotomy ◽  
Cavus Foot ◽  
One Year

Category: Hindfoot Introduction/Purpose: A calcaneal osteotomy can be used to treat a variety of pathologic entities in which the hindfoot needs realignment. Minimally invasive calcaneal osteotomy (MICO) is becoming increasingly popular due to being soft tissue friendly, its ability to place other incisions nearby and high union rate. Previous studies have look specifically at medialising MICO or comparing open calcaneal osteotomy versus MICO. The purpose of our study was to compare 3 different types of commonly used MICO in our centre. Methods: Sixty-two MICO which fit the criteria were included in this study. They were performed in our unit from 2010 and 2016 and all patients had at least one year follow up data. The type of osteotomies was as follows: Medialising, n = 34, Lateralising, n =15 and Zadek (Dorsal closing wedge), n =13. Clinical and radiographic data were recorded. The diagnosis for 31/34 of the medialising MICO was Stage 2 PTTD, the diagnosis for 12/15 of the lateralising MICO was cavus foot, while the diagnosis for all Zadek MICO was for insertional Achilles tendinopathy. Apart from the Zadek MICO, the other MICO were all associated with other procedures. The average age (years) were as follows: Medialising, 58 (30 – 74); Lateralising, 33 (14 – 67) and Zadek, 47 (42-62). Results: The average calcaneal displacement was 10.2 (range: 8 – 12) mm for medialising MICO, and 6.6 (4 – 8) mm for lateralising MICO(p=0.021). Average time to union was 7.8 (5.4 – 11.6) weeks for medialising MICO, 6.2 (4.6 to 7.9) weeks for lateralising MICO, and 6.1 (4.1 – 7.6) weeks for Zadek MICO. All the MICO healed radiologically and clinically. Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported transient sural nerve paraesthesia following surgery. Wound problems developed in 5 patients (Lateralising, n =3; Zadek, n =2). The number of total complications were as follow: Medialising, n = 5, Lateralising, n = 7 and Zadek, n =5. Average length of stay was as follows: Medialising, 2(0-8) days; Lateralising, 1(0-3) day and Zadek, 1(0-3) day. Conclusion: Minimally invasive calcaneal osteotomy was safe with a high union rate and low complication rates and length of stay across all 3 common osteotomies. The average calcaneal displacement was significantly less for lateralising than medialising which is similar to reported figures for open osteotomy. Wound problems were more likely for lateralising and Zadek MICO compared to medialising and this could be because of how the osteotomies are shifted.

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy

2020 ◽  
Vol 64 (1) ◽  
pp. 22-27
Author(s):  
L. López-Capdevila ◽  
A. Santamaria Fumas ◽  
A. Dominguez Sevilla ◽  
J.M. Rios Ruh ◽  
E. Pich Aguilera ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendinopathy ◽  
Calcaneal Osteotomy ◽  
Insertional Achilles Tendinopathy

scholarly journals Return to Play After Open Calcaneoplasty for Insertional Achilles Tendinopathy With Haglund Deformity in Competitive Professional Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Kyung Tai Lee ◽  
Jegal Hyuk ◽  
Sung Jae Kim
Keyword(s):  
Body Mass Index ◽  
Surgical Treatment ◽  
Body Mass ◽  
Achilles Tendinopathy ◽  
Return To Play ◽  
Professional Athletes ◽  
Haglund Deformity ◽  
Mean Time ◽  
Insertional Achilles Tendinopathy

Background: Surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes has not been previously investigated. Purpose: To assess clinical outcomes, including return to play (RTP), after surgical treatment of insertional Achilles tendinopathy in professional athletes. Study Design: Case-control study; Level of evidence, 3. Methods: This retrospective study included 20 professional athletes who were surgically treated for insertional Achilles tendinopathy and had at least 2 years of follow-up. An open longitudinal lateral approach was used for the operation, without violation of the Achilles tendon. Outcome evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, subjective patient satisfaction, mean time of return to competition (RTC), and rate of RTP. We defined RTC as return to an official match for at least 1 minute and RTP rate as the percentage of patients who were able to participate in at least 2 full seasons. A subgroup analysis was performed to compare the RTP and no-RTP groups. Results: The AOFAS score improved significantly from preoperatively to the final follow-up (from 65.1 to 88.4; P < .001), and 75% of the patients reported good to excellent satisfaction. The mean time of RTC was 7.45 months (range, 4-18 months), and the rate of RTP was 60%. The RTP group had a significantly lower mean body mass index than did the no-RTP group (22.03 vs 23.86, respectively; P = .005) and faster mean RTC (5.0 vs 11.1 months, respectively; P < .001). Conclusion: Open calcaneoplasty for surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes should be approached cautiously. Our patients had a 7.5-month recovery period before return to their first official match, and only 60% of the patients returned to their sports activity and participated in at least 2 full seasons. Lower body mass index and a faster RTC after surgery were related to longer functional maintenance.

Proximal to Distal Exostectomy for the Treatment of Insertional Achilles Tendinopathy

2018 ◽  
Vol 11 (4) ◽  
pp. 362-364 ◽  
Author(s):  
Zachary L. McBeth ◽  
Joseph W. Galvin ◽  
Justin Robbins
Keyword(s):  
Achilles Tendon ◽  
Subtalar Joint ◽  
Soft Tissues ◽  
Achilles Tendinopathy ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Calcaneal Osteotomy ◽  
Insertional Achilles Tendinopathy

When insertional Achilles tendinopathy is addressed surgically via a central-Achilles splitting approach, the calcaneal osteotomy has classically been performed from distal to proximal. We describe a simple proximal to distal technique that allows optimal resection of both the calcaneal exostosis and Achilles enthesophyte, minimizes risk to the soft tissues and skin, provides a bony attachment surface parallel to the axis of the Achilles tendon, and avoids the risk of osteotomy extension into the subtalar joint. Levels of Evidence: Level V: Technique tip

scholarly journals Dorsally Based Closing Wedge Osteotomy of the Calcaneus for Insertional Achilles Tendinopathy

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090798 ◽  
Author(s):  
Nicola Maffulli ◽  
Alessio D’Addona ◽  
Nikolaos Gougoulias ◽  
Francesco Oliva ◽  
Gayle D. Maffulli
Keyword(s):  
Surgical Techniques ◽  
Achilles Tendinopathy ◽  
Wedge Osteotomy ◽  
Safe Procedure ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Calcaneal Osteotomy ◽  
And Function ◽  
Insertional Achilles Tendinopathy ◽  
Sports Activities

Background: Surgical management may be indicated for patients with insertional Achilles tendinopathy (IAT) after failure of nonoperative management, and various surgical techniques have been described. Hypothesis: We present the technique and results of modified dorsal closing wedge calcaneal osteotomy, performed in a cohort of 28 consecutive patients. We hypothesized that this will be a safe procedure that can improve hindfoot pain and function for most patients who will return to preoperative daily life and sports activities. Study Design: Case series; Level of evidence, 4. Methods: A modified dorsal closing wedge osteotomy was performed in 28 patients (mean age, 54.7 years) from November 2015 to December 2016. All patients were followed for at least 2 years postoperatively. Results: All osteotomies united at a mean of 5 weeks. The mean anatomic change in calcaneal length was 4 mm (range, 3-6 mm). The overall complication rate was 10.7%. There were 2 superficial wound infections (7.1%) and 1 instance of sural nerve–related paresthesia (3.5%) reported. All patients returned to their presurgical level of activities at a mean of 23 ± 8.0 weeks. Further, 3 of 4 patients who participated in recreational sports activities returned to their preinjury level. Visual analog scale and Victorian Institute of Sports of Australia–Achilles scores significantly improved postoperatively ( P < .001) and continued to improve for 24 months. Conclusion: The modified dorsal closing wedge calcaneal osteotomy is a safe procedure and significantly improved pain and function in patients with IAT at 2 years after surgery.

Minimally Invasive Paratenon Release for Non-Insertional Achilles Tendinopathy

2009 ◽  
Vol 30 (7) ◽  
pp. 680-685 ◽  
Author(s):  
Venunatha Naidu ◽  
Ali Abbassian ◽  
Dominic Nielsen ◽  
Raju Uppalapati ◽  
Anupkumar Shetty
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendinopathy ◽  
Insertional Achilles Tendinopathy

Endoscopic Haglund’s Resection and Percutaneous Double-Row Insertional Achilles Repair

2021 ◽  
pp. 193864002110027
Author(s):  
Christopher P. Miller ◽  
James R. McWilliam ◽  
Max P. Michalski ◽  
Jorge Acevedo
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Suture Anchor ◽  
Surgical Techniques ◽  
Achilles Tendinopathy ◽  
Wound Complications ◽  
Double Row ◽  
Suture Anchor Repair ◽  
Insertional Achilles Tendinopathy

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

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

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