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 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.

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

2021 ◽  
pp. 193864002110336
Author(s):  
LT Thomas J. Kelsey ◽  
LT Kyle W. Mombell ◽  
CDR Todd A. Fellars
Keyword(s):  
Achilles Tendon ◽  
Suture Anchor ◽  
Maximum Load ◽  
Achilles Tendinopathy ◽  
Catastrophic Failure ◽  
Double Row ◽  
Average Load ◽  
Load To Failure ◽  
Insertional Achilles Tendinopathy ◽  
Repair Techniques

Background In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Methods Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. Results The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure ( P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). Conclusion This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

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 Effects of Achilles Tendon Moment Arm Length on Insertional Achilles Tendinopathy

2020 ◽  
Vol 10 (19) ◽  
pp. 6631
Author(s):  
Takuma Miyamoto ◽  
Yasushi Shinohara ◽  
Tomohiro Matsui ◽  
Hiroaki Kurokawa ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Moment Arm ◽  
Healthy Individuals ◽  
Suture Bridge ◽  
Significant Difference ◽  
The Moment ◽  
Insertional Achilles Tendinopathy ◽  
Suture Bridge Technique

Insertional Achilles tendinopathy (IAT) is caused by traction force of the tendon. The effectiveness of the suture bridge technique in correcting it is unknown. We examined the moment arm in patients with IAT before and after surgery using the suture bridge technique, in comparison to that of healthy individuals. We hypothesized that the suture bridge method influences the moment arm length. An IAT group comprising 10 feet belonging to 8 patients requiring surgical treatment for IAT were followed up postoperatively and compared with a control group comprising 15 feet of 15 healthy individuals with no ankle complaints or history of trauma or surgery. The ratio of the moment arm (MA) length/foot length was found to be statistically significant between the control group, the IAT group preoperatively and the IAT group postoperatively (p < 0.01). Despite no significant difference in the force between the control and preoperative IAT groups, a significantly higher force to the Achilles tendon was observed in the IAT group postoperatively compared to the other groups (p < 0.05). This study demonstrates that a long moment arm may be one of the causes of IAT, and the suture bridge technique may reduce the Achilles tendon moment arm.

Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy

2021 ◽  
pp. 107110072110038
Author(s):  
Marut Arunakul ◽  
Waroot Pholsawatchai ◽  
Preeyaphan Arunakul ◽  
Akaradech Pitakveerakul
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Accelerated Program ◽  
Suture Bridge ◽  
Sf 36 ◽  
Prospective Comparative Study ◽  
Insertional Achilles Tendinopathy

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.

scholarly journals Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199295
Author(s):  
Changgui Zhang ◽  
Jin Cao ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Bone Marrow ◽  
Surgical Treatment ◽  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Bone Marrow Oedema ◽  
High Signal ◽  
Retrocalcaneal Bursitis ◽  
Retrocalcaneal Bursa ◽  
Insertional Achilles Tendinopathy

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.

scholarly journals Tensile mechanical changes in the Achilles tendon due to Insertional Achilles tendinopathy

2020 ◽  
Vol 112 ◽  
pp. 104031
Author(s):  
Ibrahima Bah ◽  
Ninoshka R.J. Fernandes ◽  
Ruth L. Chimenti ◽  
John Ketz ◽  
A. Samuel Flemister ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Insertional Achilles Tendinopathy
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