Abordaje quirúrgico de la enfermedad de Haglund: revisión bibliográfica

Objetivos: Conocer cuál de los dos abordajes quirúrgicos presenta menos complicaciones y mejores resultados post-quirúrgicos según las escalas descritas, para el tratamiento de la enfermedad de Haglund: endoscópico o abierto.Material y métodos: Se consultaron las bases de datos Pubmed, Bucea, Enfispo y Dialnet, desde enero del 2003 hasta 2018, en español y en inglés, bajo los términos siguientes: “Haglund’s deformity”, “treatment Haglund”, “Haglund síndrome”, “Diagnostic Haglund”, "Haglund surgery”, “Calcaneal osteotomy”, “Haglund”.Resultados: Se incluyeron 33 artículos para la realización de este trabajo, de los cuales 13 eran estudios en los que se mostraba la comparación entre tratamiento quirúrgico abierto y endoscópico en sujetos con deformidad de Haglund. Se incluyeron 393 sujetos de los cuales se intervinieron 415 pies (161 por vía endoscópica y 187 mediante abordaje abierto). 58% de los sujetos tratados por endoscopia calificaron este tratamiento como excelente y las complicaciones reportadas, que fueron menores, sólo estuvieron presentes en 2 individuos, a diferencia de los tratados con cirugía abierta, donde 8 presentaron complicaciones menores y 5 complicaciones mayores.Conclusiones: El abordaje endoscópico tiene un porcentaje mayor de satisfacción según los resultados post-quirúrgicos obtenidos además de una menor tasa de complicaciones.

Endoscopic management of retrocalcaneal pain: a prospective observational study

<p class="abstract"><strong>Background:</strong> In an effort to reduce morbidity and complications of open surgery, an endoscopic technique was used for the management of the conditions leading to retrocalcaneal pain. With this purpose, the current study was undertaken to evaluate results of endoscopic management of retrocalcaneal pain using American orthopaedic foot and ankle score (AOFAS).</p><p class="abstract"><strong>Methods:</strong> 20 patients (26 heels) in the age group 18-80 years presenting with retrocalcaneal pain not responding to conservative management underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. Two portals were created, one laterally and one medially, over the posterosuperior portion of the calcaneus to gain access to the retrocalcaneal space. The inflamed bursal tissue was identified and removed, and the prominent bone was resected. The functional outcome was evaluated pre and postoperatively with the AOFAS.<strong></strong></p><p class="abstract"><strong>Results:</strong> 70% patients have retrocalcaneal bursitis, 20% Haglund’s deformity as confirmed on lateral view of ankle X-ray and only 10% of non-insertional tendinosis. Mean operative time was 54.95 minutes. Mean duration of hospital stay was 3.90±0.64 and the mean follow-up was 66 days (range 30-180 days). The average AOFAS score improved from 65.60 points pre-operatively to 96.80 points at final follow-up. There were fifteen excellent results, seven good results, two fair results and two poor results.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic procedure for retrocalcaneal bursitis and Haglund deformity seemed to be a safe and efficacious option for surgical treatment of retrocalcaneal pain.</p>

Use of Ultrasonically Interdigitated Anchors in Haglund’s Deformity Correction Surgery

Haglund’s deformity is a common cause of foot pain, with high success rates of surgical intervention. Because early weightbearing rehabilitation correlates with better surgical results, the integrity of anchors employed in these surgeries needs to be evaluated for proper fixation strength, leading to improved postoperative outcomes. The ultrasonically interdigitated anchor is a biodegradable suture anchor that is melted into bony trabeculae using ultrasound, leaving a small biological footprint and less interference on computed tomography and magnetic resonance imaging scans, without loss of fixation strength. We performed a review of 44 patients aged 26 to 84 years treated with either ultrasonically interdigitated anchors or fully threaded titanium anchors during Haglund’s deformity excision. Overall, 7 of 14 patients who received an ultrasonically interdigitated anchor reported raw PROMIS (Patient-Reported Outcomes Measurement Information System) scores averaging 14.3, with an average return to ambulation time of 4.2 weeks. Fifteen of 30 patients receiving a fully threaded titanium anchor reported raw PROMIS scores averaging 9.7, with an average return to ambulation time of 3.5 weeks. We found little difference between the outcomes between the 2 anchors and no massive failures or infections in either group, implying that ultrasonically interdigitated anchors are a viable option for Achilles tendon reattachment during Haglund’s deformity repair surgery. Levels of Evidence: Level III: Case control study

Endoscopic Calcaneoplasty in an Elite Runner

Haglund’s syndrome is a triad of postero-superior calcaneal prominence, retro-calcaneal bursitis and insertional Achilles tendinopathy. Endoscopic treatment of patients with this triad allows for earlier weight bearing, direct visualization of the Achilles insertion and less soft tissue disruption. In addition, it allows excellent visualization of the pathology. We report a case of an elite runner that underwent Endoscopic Calcaneoplasty done in the prone position. Prospective analysis of his performance before and after the surgical intervention as well as post-operative rehabilitation is detailed. Prone positioning allows for easier accessto the Haglund’s deformity, a more logical view on the monitor and a more ergonomic hand position.