Category: Hindfoot Introduction/Purpose: Insertional Achilles tendinopathy is a common musculoskeletal disorder that can impair physical function in daily living and athletic and occupational performance. It has been previously reported that up to one-third of patients who present with this condition will undergo surgical treatment due to failure of conservative management. To date, insertional Achilles tendinopathy outcomes within the military have not been reviewed. Furthermore, surgical correction of symptomatic Achilles tendinopathy often does not lead to a return to restriction-free active duty. Therefore, it is of great interest to evaluate the outcomes of non-operative and operative management and the ability for the service member to return to duty following treatment of insertional Achilles tendinopathy. Methods: A single center retrospective review of consecutive patients with ICD-9, ICD-10 and CPT codes for diagnosis of Achilles tendon and calcaneal coding were reviewed from January 2007-May2017. Inclusion criteria included active duty military, failure of at least 3 months of conservative management and surgical treatment utilizing a retrocalcaneal exostectomy, Achilles tendon debridement followed by reattachment as necessary. Radiographic and clinical data collection was completed on all patients who met inclusion criteria to determine pre- and post-operative changes in pain and function. VAS pain scores were collected pre-op, and at 3, 6 12 and 24mo post-op. Operative reports were reviewed to confirm specific operative findings and repair technique. Surgical treatment was achieved with medial incision, fluoroscopy guided spur/Haglund deformity resection and reattachment of the Achilles tendon utilizing suture anchor constructs. Return to duty and profile status were recorded as outcome measures. Results: Our data analysis included 70 patients with the majority of patient from the Army (41 pts). Average age at treatment was 36.6yo (range, 21-54). Tobacco use was observed in 13 patients (18.57%). Length of pre-operative physical therapy averaged 6.5 months (range, 2-36mo). Other modalities prior to operative correction were also recorded with 20% receiving a PRP injection, 1.43% received a steroid injection, 14% of patients received ECSWT. Surgical treatment complications were observed in 16 patients (13%). VAS scores significantly improved at one year from 5.6 pre-op to 3.2 post-op (n=26.) At 1 year,60% of patient went onto return to full duty, 25% of patients remained on profile, 5% of patients retired, 10% of patients went onto medical evaluation board for separation from the military. Conclusion: To our knowledge, this is the first study to evaluate the outcomes of insertional Achilles tendinopathy in an active military population. Insertional Achilles tendinopathy prevalence within the military is a common condition with incidence rates likely higher than the general population which previously reported to between 15-24%. In conclusion, with a 60% return to duty rate and significant reduction of subjective pain scores, this is a viable treatment option for patients who could not otherwise remain on active duty but the complication rate is high (13%) and patients and providers should consider the risks during their shared decision making process.
Level of Evidence for the Treatment of Chronic Noninsertional Achilles Tendinopathy