Background: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. Results: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 ( P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% ( P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. Conclusion: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems Level of Evidence: Level III, retrospective study.

We report the case of a 66-year-old male patient with massive ossification of the distal portion of the Achilles tendon, as a late consequence of a surgical release for club foot conducted in his childhood. The singularity of the case report derives from its clinical features: the bone mass was of abnormal dimensions, almost substituting the entire tendon; the condition had always been asymptomatic, without deficits in range of motion, in absence of either pain or biomechanical defects with age. In fact, the condition was diagnosed just recently as a consequence of a tear. Despite an ultrasound diagnosis after the injury, only during the surgical treatment, a proper evaluation of the entity of the pathology was possible. Although the ossification of Achilles tendon is a rare clinical condition with a complex multifactorial etiology, in our case report, some of the elements in the patient’s medical history could be useful for the pathogenesis and early diagnosis of the disease. The aim of this case report is to emphasize the importance both of a correct evaluation of clinical history and of an accurate diagnosis, in order to conduct a proper management of this pathology.

Background Osteochondritis dissecans (OCD) is an idiopathic disease due to a subchondral bone necrosis that generally affects the medial femoral condyle as well as above lying cartilage. The incidence of patients with OCD of the knee aged 6 to 19 years was 9.5 per 100,000 overall and 15.4 and 3.3 per 100,000 for male and female patients, respectively. Bilateral lesions occur in at least 10-12 % of the OCD patients. The typical patient is male (70%), between 6 and 19 years of age who has participated in organized sports, and overall 20-40% of all cases have a history of knee trauma. The etiology has been hypothesized as being multi-factored due to traumas or microtraumas along with metabolic, endocrine and genetic disorders leading to subchondral necrosis. Description of case A 15-year old male amateur soccer player presented to our department complaining of recurrent episodes of pain at rest in both knees, swelling and articular blockage occurring over the past three years. RX and MRI revealed bilateral lesions on both medial condyles. An innovative one-time surgical technique was performed to resolve the disease. Conclusion Here, we describe a rare case of bilateral OCD of the knees where each of the osteochondral lesions was evaluated taking into account results from a physical exam, imaging, and arthroscopy. The patient underwent a surgical approach that incorporated both the withdrawal and transplant of stems into the lesions, the rationale of the "one-time technique" is based on the idea to transfer into the lesion site the entire bone marrow cellular pool; this allows not to loose "regenerative potential" present in the bone marrow and cells to be processed directly in the operating room without the need for a laboratory phase. A radiograph performed at six months showed remarkable results concerning tissue response. This case further highlights past cases regarding results, while it distinguishes itself for the fact that it has been performed on bilateral knees lesions.

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