The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study

Abstract Background: Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated. Methods: This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics.Results: The VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836).Conclusions: In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. Trial registration: DRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .

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Achilles tendon detachment after local infiltration of corticosteroids

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1221 ◽

2021 ◽

Vol 15 (1) ◽

pp. 73-76

Author(s):

Jorge Del Vecchio ◽

Eric Dealbera ◽

Jorge Batista ◽

Mauricio Ghioldi ◽

Lucas Chemes

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Imaging Studies ◽

Level Of Evidence ◽

Local Infiltration ◽

Achilles Tendinosis ◽

Retrocalcaneal Bursitis ◽

Retrocalcaneal Bursa ◽

Haglund Deformity

Complete disinsertion of the Achilles tendon is relatively rare but is an injury of considerable clinical significance. A 50-year-old non-smoking man presented with complete disinsertion of the Achilles tendon due to an indirect low-energy trauma shortly after administration of local corticosteroid injections (LCI) for treatment of deep retrocalcaneal bursitis. Imaging studies showed complete disinsertion of the Achilles tendon as well as severe Haglund syndrome and retrocalcaneal bursitis. The tendon was repaired, and the Haglund deformity and retrocalcaneal bursa were then resected. Although Achilles tendon rupture is a frequent complication after LCI, to date, no cases of disinsertion have been published. Surgeons must be aware of this issue, especially in patients with previous insertional calcific Achilles tendinosis and Haglund syndrome. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

10.21203/rs.3.rs-23312/v1 ◽

2020 ◽

Author(s):

Heinz Lohrer

Keyword(s):

Achilles Tendon ◽

Treatment Strategies ◽

Exclusion Criteria ◽

Treatment Groups ◽

Partial Tear ◽

Partial Tears ◽

Outcome Scores ◽

Respective Treatment ◽

Retrocalcaneal Bursa

Abstract BackgroundAchilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated.MethodsThis study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by descriptive statistics.ResultsThe VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18–73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10–73) for the midportion Achilles tendon partial tear group, respectively (p = 0.690). At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups (p = 0.002).ConclusionsIn Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Twelve months postoperatively and at final follow-up, however, results were significantly better in the midportion Achilles tendon partial tear group.Trial registrationDRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .

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The Achilles tendon and the retrocalcaneal bursa

Bone and Joint Research ◽

10.1302/2046-3758.67.bjr-2016-0340.r1 ◽

2017 ◽

Vol 6 (7) ◽

pp. 446-451 ◽

Cited By ~ 5

Author(s):

P. A. Pękala ◽

B. M. Henry ◽

J. R. Pękala ◽

K. Piska ◽

K. A. Tomaszewski

Keyword(s):

Achilles Tendon ◽

Retrocalcaneal Bursa

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Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01856-7 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Heinz Lohrer

Keyword(s):

Achilles Tendon ◽

Repeated Measures ◽

Treatment Strategies ◽

Systematic Effect ◽

Partial Tear ◽

Partial Tears ◽

Significant Difference ◽

Respective Treatment ◽

Retrocalcaneal Bursa

Abstract Background Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways, and different treatment strategies are applied. The outcome is rarely investigated. Methods This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics. Results The VISA-A-G outcome scores improved significantly from preoperative to 6 months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18–73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10–73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836). Conclusions In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. Trial registration DRKS, DRKS00014266. Registered 06 April 2018. ‘Retrospectively registered’, https://www.drks.de/drks_web/navigate.do?navigationId=results.

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An anatomical and radiological study of the fascia cruris and paratenon of the Achilles tendon

Foot and Ankle Surgery ◽

10.1016/j.fas.2010.06.003 ◽

2011 ◽

Vol 17 (3) ◽

pp. 186-192 ◽

Cited By ~ 21

Author(s):

M.R. Carmont ◽

A.M. Highland ◽

J.R. Rochester ◽

E.M. Paling ◽

M.B. Davies

Keyword(s):

Achilles Tendon ◽

Radiological Study

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

Journal of International Medical Research ◽

10.1177/0300060521992959 ◽

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.

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Surgical Treatment of Achilles Tendinitis by Decompression of the Retrocalcaneal Bursa and the Superior Calcaneal Tuberosity

The American Journal of Sports Medicine ◽

10.1177/03635465020300030301 ◽

2002 ◽

Vol 30 (3) ◽

pp. 318-321 ◽

Cited By ~ 76

Author(s):

Marilyn L. Yodlowski ◽

Arnold D. Scheller ◽

Lampros Minos

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Nonoperative Treatment ◽

Achilles Tendinitis ◽

Lateral Border ◽

Pain Scores ◽

Retrocalcaneal Bursa ◽

Calcific Deposits ◽

Calcaneal Tuberosity

Background Initial nonoperative treatment of pain at the Achilles tendon, often referred to as “tendinitis,” is not always successful. Hypothesis Surgical treatment is effective for patients with insertional tendinitis unrelieved by nonoperative measures. Study Design Retrospective cohort study. Methods Thirty-five patients (41 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. The technique consisted of a single incision along the lateral border of the Achilles tendon. The dissection exposed the retrocalcaneal bursa and fat pad, which were completely excised along with any scarred and thickened paratenon. A partial calcaneal exostectomy of the tubercle was performed. Results At a minimum follow-up of 20 months (average, 39), the patients’ pain scores (rated from 0 to 6) improved from 4.7 (SD, 1.1) preoperatively to 1.5 (SD, 1.3); 90% had complete or significant relief of symptoms, 10% felt improved, and none felt unchanged or worse. Conclusions Surgical treatment of chronic Achilles tendon pain with resection of the prominent tuberosity, complete debridement of the bursa, excision of thickened, scarred paratenon, and removal of accessible calcific deposits within the tendon is an effective treatment.

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Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

10.21203/rs.3.rs-23312/v2 ◽

2020 ◽

Author(s):

Heinz Lohrer

Keyword(s):

Achilles Tendon ◽

Repeated Measures ◽

Treatment Strategies ◽

Systematic Effect ◽

Partial Tear ◽

Partial Tears ◽

Significant Difference ◽

Respective Treatment ◽

Retrocalcaneal Bursa

Abstract Background: Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated. Methods: This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics. Results: The VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups.A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836). Conclusions: In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups.

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