Surgery for achilles tendinopathy

NewsBot · Jul 1, 2024

The surgical learning curve for percutaneous Zadek osteotomy for treatment of insertional achilles tendinopathy
SarahRose Hall et al
Arch Orthop Trauma Surg. 2024 Jun 26

Introduction: The Zadek Osteotomy has been described as an effective technique for the treatment of insertional Achilles tendinopathy. Recently, this strategy has been modified using minimally invasive techniques. A learning curve has been observed in many minimally invasive procedures in foot and ankle surgery. This retrospective study first intended to evaluate if there is a learning curve associated with the percutaneous Zadek Osteotomy. Further, if a learning curve was observed, we planned to assess the data for associated changes in complications and postoperative outcomes.

Methods: A retrospective analysis of 98 patients who underwent percutaneous Zadek Osteotomy was performed. Patient charts were reviewed for operative times, complications, union rates, and Foot Function Index (FFI) and Visual Analogue Scale (VAS) scores. Analysis of variance was utilized to assess for differences between groups of cases.

Results: Patients included 61 females and 37 males. Mean age was 51.28 ± 11.12 (range 28-81) years. Mean follow-up time was 42.07 ± 12.99 (range 24-65) months. Significant increases in operative times were observed in cases 1-14 when compared to cases 15-98 (p < 0.001). Improvements in FFI and VAS scores were observed at final follow-up within each case group (p < 0.001); there were no differences detected in FFI or VAS scores between groups of cases. There was no difference detected in number of complications between intervals of cases.

Conclusion: A learning curve was observed for the percutaneous Zadek Osteotomy, which was overcome around case 14. This learning curve was only observed in terms of procedure length. A surgeon's level of inexperience with the technique does not appear to affect functional outcomes, nonunion, or need for revision.
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NewsBot · Jul 2, 2024

Endoscopic Calcaneal SpeedBridge Technique: Decreased Post-Operative Complication Rate in Insertional Achilles Tendinopathy
Juliette Fradet, Ronny Lopes
Orthop Traumatol Surg Res. 2024 Jun 15

Background: An endoscopic calcaneal SpeedBridge technique was described recently. The primary objective of this study was to report the post-operative complications seen with calcaneal SpeedBridge repair. The secondary objective was to report short- and medium-term functional outcomes.

Hypothesis: Post-operative complications are less common with endoscopic vs. open SpeedBridge suturing.

Material and methods: The endoscopic SpeedBridge technique was used in 9 patients who had insertional Achilles tendinopathy refractory to conservative management. The patients were evaluated at least 24 months after the procedure. Infectious and wound-healing complications were recorded. Visual analogue scale (VAS) scores for pain and patient satisfaction, shoeing difficulties, the European Foot and Ankle Society (EFAS) score, and the Victorian Institute of Sport Assessment-Achilles (VISA-A) score were assessed.

Results: During the mean follow-up of 25.3 months, no complications were recorded. The EFAS and VISA-A scores were 37/40 and 91/100, respectively. The mean VAS scores for pain and satisfaction were 1.7/10 and 9.3/10, respectively. No patients reported shoeing difficulties.

Conclusion: Endoscopic calcaneal SpeedBridge suturing is associated with a lower complication rate compared to the open variant. Clinical outcomes are highly satisfactory in the short and middle terms.
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NewsBot · Jul 25, 2024

Excellent Clinical Outcomes and Rapid Return to Activity Following In-Office Needle Tendoscopy for Chronic Achilles Tendinopathy
James J Butler et al
Arthrosc Sports Med Rehabil. 2024 Apr 9;6(3):100937.

Purpose: To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up.

Methods: A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment-Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale.

Results: Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment-Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9.

Conclusions: This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up.
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NewsBot · Aug 14, 2024

Dorsal calcaneal wedge removal in zadek osteotomy: A cadaveric study
Jonathan R.M. Kaplan et al
Foot and Ankle Surgery; Volume 30, Issue 6, August 2024, Pages 516-519

Background
Insertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO.

Methods
The ZO was performed on six cadaveric specimens. A 7.5 mm and 15 mm wedge osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen’s d analysis.

Results
Maximal DF was 110.87 ± 12.97 deg in the pre-osteotomy state. Removal of a 7.5 mm wedge improved DF by 8 deg to a mean 102.93 ± 13.81 deg (p = 0.08). Removal of a 15 mm wedge improved DF by 16 deg to a mean 95.96 ± 11.41 deg (p = 0.003). Cohen’s d and effect size calculation demonstrated a 7.5 mm wedge to have a small effect on DF, while a 15 mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5 mm wedge, or 15 mm wedge positions. ICC was 0.96.

Conclusion
Based on the results presented in this study, removal of a 15 mm wedge with ZO yields significant and greater improvement in ROM than a 7.5 mm wedge. We hope the current study will better inform preoperative planning for ZO.
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NewsBot · Sep 10, 2024

Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy
SarahRose Hall et al
Foot Ankle Int. 2024 Sep 1

Background: Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up.

Methods: One hundred eight cases treated with percutaneous ZO with a minimum 2-year follow-up were retrospectively reviewed. Postoperative complications and patient satisfaction were evaluated. Foot Function Index (FFI) and visual analog scale (VAS) scores were recorded at preoperative and follow-up appointments to measure patients' functional outcomes and pain, respectively.

Results: Mean follow-up was 41.2 months (range, 24-65). Mean age was 51.8 years (range, 28-81). The mean FFI score improved from 56.1 (range, 47-88) to 11.0 (range, 7-59) postoperatively (P < .001). The mean VAS score improved from 7.7 (range, 5-10) to 0.4 (range, 0-7) postoperatively (P < .001). The overall complication rate was 3.8% (n = 4). Of 104 cases, 98.1% of patients said they were satisfied with their procedure (n = 102) when asked if they were satisfied with their ZO and recovery.

Conclusion: We found the percutaneous ZO to be a safe and effective intervention for treatment of IAT. At a minimum of 2-year follow-up, this intervention is associated with minimal complications, improved function, reduced pain, and a high rate of patient satisfaction.Level of Evidence: Level IV, retrospective cohort study.
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NewsBot · Oct 6, 2024

Comparison of open and endoscopic techniques of isolated calcaneoplasty in the surgical treatment of insertional tendinopathy of the Achilles tendon
Alexis Thiounn et al
Orthop Traumatol Surg Res. 2024 Sep 25

Introduction: Insertional Achilles tendinopathy (IAT) is primarily caused by mechanical overload. Running and obesity are major risk factors. Medical treatment is limited, and surgery, particularly calcaneoplasty, is sometimes necessary. However, the choice between an endoscopic and open approach remains controversial.

Hypothesis: This study is based on the hypothesis that endoscopic surgery would allow for better functional recovery with a faster return to sports activity compared to traditional open techniques.

Materials and methods: Our multicenter prospective study compared the outcomes of endoscopic (Endo) and open (Open) calcaneoplasty in patients with IAT resistant to medical treatment. Clinical outcomes were assessed using the EFAS (daily life and sports) and VISA-AF scores. The radiological criteria studied were the calcaneal slope and the X/Y ratio. An MRI was used to quantify tendon involvement.

Results: Of the 85 patients included, 51 underwent endoscopic surgery, and 34 had open surgery. The two groups were comparable in terms of demographic, clinical, and radiographic characteristics. At 3 months postoperatively, significantly more patients had returned to sports in the Endo group (41.6% vs. 20.6% in the Open group; p = 0.004), and the EFAS sports score showed a significant difference in favor of the Endo group at 6 months postoperatively (9.3 vs. 5.7/16; p = 0.008).

Discussion: The results confirm faster recovery after endoscopic surgery, with comparable complication rates between the two approaches. However, long-term, the differences between the two techniques diminish, with similar functional outcomes at 12 months postoperatively.

Conclusion: Endoscopic calcaneoplasty is a safe and effective option for the treatment of IAT. However, further studies with longer follow-up are needed to confirm these results and assess recurrence rates.
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NewsBot · Oct 7, 2024

Open and Percutaneous Approaches Have Similar Biomechanical Results for Primary Midsubstance Achilles Tendon Repair: A Meta-analysis
Jonathan Lawson et al
Arthroscopy, Sports Medicine, and Rehabilitation Volume 6, Issue 3 , June 2024, 100924

Purpose
To evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair.
Methods
A systematic review of original research articles was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To qualify for study inclusion, articles were required to be published in English, use a laboratory design using either human or animal tissue, and directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique with percutaneous repair using either a locking or nonlocking suture construct. The biomechanical outcomes evaluated were displacement (millimeters) and load to failure (Newtons).
Results
Twelve studies met inclusion criteria, including 234 specimens (open: 97, percutaneous locking: 73; percutaneous nonlocking: 64) that underwent primary midsubstance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (P = .240) or load to failure (P = .912) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (P = .109) between the locking and nonlocking tendon repair systems.
Conclusions
The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary midsubstance Achilles tendon repair.
Clinical Relevance
In clinical studies, similar rerupture rates have been observed after open or percutaneous Achilles tendon repair. It may be beneficial for surgeons to understand whether biomechanical differences exist between these repair techniques.
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NewsBot · Oct 13, 2024

Biomechanical Changes to the Hindfoot After Zadek Osteotomy
Nicholas Bellas et al
Foot Ankle Int. 2024 Oct 13

Background: Insertional Achilles tendinopathy (IAT) is a common source of heel pain in active adults and athletes. The Zadek osteotomy (ZO) is a calcaneal dorsal closing wedge osteotomy that has demonstrated clinical success as a treatment for IAT, purported to favorably improve tendon mechanics, decrease impingement, and decrease pressure within the retrocalcaneal bursa. The present study aims to evaluate the biomechanical effects of ZO on Achilles strain, position of the Haglund prominence relative to the Achilles insertion, and retrocalcaneal pressure.

Methods: The ZO was performed on 10 fresh-frozen foot and ankle mid tibia-fibula cadaveric specimens. An osteotomy was performed using a 1-cm dorsal closing wedge procedure secured with a 7.0 mm cannulated screw. Point pressure sensor catheters and differential variable reluctance transducers were used to measure the retrocalcaneal pressure and Achilles strain, respectively, pre- and postosteotomy. Paired t-tests were utilized to detect statistical differences (P < .05).

Results: After the ZO, the Haglund prominence was translated 9.9 mm anteriorly with respect to the insertion of the Achilles (P < .05) and the Achilles tendon insertion was translated 3.4 mm proximally (P < .05). The ratio of calcaneal length to greater tuberosity length, the X/Y ratio, increased from 2.56 to 3.52 with the osteotomy (P < .05). At maximum dorsiflexion, retrocalcaneal pressure decreased from 117 to 66 mm Hg (44%, P = .018). The Achilles strain changed from 0.00362 to 0.00436 in the anterior fibers (P = .484) and changed from 0.00467 to 0.00283 in the posterior fibers (P = .088).

Conclusion: Biomechanical testing in a cadaveric model demonstrates that the ZO decreased retrocalcaneal pressure, shifted the Achilles tendon insertion proximally, increased the X/Y ratio of the calcaneus, and did not significantly change the strain of the Achilles tendon.

Clinical relevance: Despite the clinical success demonstrated in recent literature, there are no biomechanical studies describing the effect of the ZO on the biomechanics of the hindfoot, and the mechanism of symptom relief of the ZO for IAT is not well understood. The present study measures two potential ZO effects relative to Haglund prominence by measuring retrocalcaneal pressure and displacement of the Achilles tendon with respect to the Haglund prominence, and measures one ZO effect relative to calcification of the tendon by measuring the Achilles tendon strain.
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NewsBot · Oct 14, 2024

Surgical Treatment of Insertional Achilles Tendinopathy Augmented With Human Acellular Dermal Matrix: A Retrospective Case Series
Bryce Corlee et al
Foot Ankle Orthop. 2024 Oct 8;9(4):24730114241284019

Background: Insertional Achilles tendinopathy (IAT) is often surgically treated with Achilles tendon partial or total detachment, debridement and repair of the Achilles tendon, excision of retrocalcaneal exostosis, and suture anchor reattachment. To date, there is no report that examines the use of acellular dermal matrix (ADM) augmentation in this procedure without the use of suture anchor reattachment.

Methods: Thirty-two female and 10 male patients (mean age 52 years) with IAT underwent surgical treatment including partial detachment of the Achilles tendon, excision of the retrocalcaneal exostosis, debridement and repair of the Achilles tendon, and augmentation with human acellular dermal matrix allograft. Outcomes measured were the visual analog scale (VAS) score, time to weightbearing, major and minor complications.

Results: Forty-two patients were followed for a mean of 20.8 months. The VAS score improved from a mean of 5.1 to 1.9 at final follow-up. The mean time to weightbearing was 4.4 weeks. Eleven patients (26.2%) experienced complications. One patient (2.4%) suffered a rupture of the Achilles in the early postoperative period. Three patients (7.1%) had delayed wound healing, with 1 (2.4%) requiring surgical debridement. Two (4.8%) experienced continued pain requiring further surgical treatment.

Conclusion: This protocol for surgical treatment of IAT with the use of human ADM allograft augmentation resulted in improved VAS scores and was associated with a low risk of postoperative infection without a prolonged nonweightbearing period.
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NewsBot · Nov 9, 2024

Impact of Dorsal Closing Wedge Calcaneal Osteotomy on Hindfoot Alignment and Biomechanics of Patients with Insertional Achilles Tendinopathy; a Weightbearing CT-based Simulation Study
Bedri Karaismailoglu et al
Foot and Ankle Surgery 8 November 2024

Purpose
Dorsal closing wedge calcaneal osteotomy (DCWCO) is purported to enhance both the biological and mechanical aspects of insertional Achilles tendinopathy (IAT) by altering its insertional anatomy. The biomechanical impacts of shifting the Achilles insertion, however, are not fully understood. This study aimed to analyze the effect of DCWCO on hindfoot alignment and gastrocnemius-soleus (G-S) power.
Methods
Six weightbearing ankle CTs of patients diagnosed with IAT were segmented and standardized planes were used to conduct DCWCOs with six variations, resulting in a total of 42-foot models including the 6 preoperative original model. Two distinct representations of plantar osteotomy starting points were defined. One was 1 cm anterior to plantar calcaneal tubercle (posterior osteotomy) and the other was 2 cm anterior (anterior osteotomy). The osteotomies were extended to 1 cm anterior of posterosuperior calcaneal tuberosity with 6-, 10-, or 14-mm dorsal wedges. Pre-defined Achilles insertion points were used to create computational Achilles tendon models. Multiple automated measurements were performed to calculate the change in foot alignment and biomechanics.
Results
Both anterior and posterior osteotomy locations resulted in decreased lateral talocalcaneal and calcaneal pitch angles, more substantially so with the anterior osteotomy (p=0.028). Distance change between Achilles and Haglund was much greater with posterior osteotomy using 6- and 10-mm wedges as compared to the anterior alternative (p=0.028). Anterior osteotomy caused a significant decrease in the Böhler angle (p<0.001). The subtalar joint orientation was observed to change up to 3.8° in anterior osteotomy and the decrease in G-S power was found to be a maximum of 2-3%.
Conclusion
A posteriorly placed starting point can provide more Achilles decompression while an anteriorly placed starting point can affect foot alignment more significantly. DCWCO can change the subtalar joint orientation predisposing the joint to increased loads. Decrease in G-S power was low and will presumably not have clinical impact.
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NewsBot · Nov 17, 2024

Achilles tendon debridement, calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and athletic performance in patients with insertional Achilles tendinopathy
Thomas Stumpner et al
Foot and Ankle Surgery; 2 June 2024

Background
Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited.
Methods
Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction.
Results
The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %.
Conclusion
Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction.
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Surgery for achilles tendinopathy

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Depression folowing surgery for an achilles tendon rupture

Achilles' tendon lengthening surgery

Joint Fusion surgery & Achilles lengthening~any advice?

Achilles Rupture - Physio Vs Surgery???

Opinions on surgery in young adolescents with rigid flat foot and shortened achilles.

Question about Surgery on Achilles

Eccentric training for the achilles tendon post surgery

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Surgery for achilles tendinopathy

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Depression folowing surgery for an achilles tendon rupture

Achilles' tendon lengthening surgery

Joint Fusion surgery & Achilles lengthening~any advice?

Achilles Rupture - Physio Vs Surgery???

Opinions on surgery in young adolescents with rigid flat foot and shortened achilles.

Question about Surgery on Achilles

Eccentric training for the achilles tendon post surgery

Share This Page

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