A Case of Calcaneal Intraosseous Lipoma along with Haglund Deformity and Chronic Tendoachilles Tear Managed using Double Row Suture Anchor Repair Augmented with FHL Graft and Curettage of Lipoma with Filling the Cavity Using Hydroxyapatite Bone Substitute

Abstract

Introduction: Achilles’ tendon is the largest tendon in the body, Tendon is an anatomical structure with inherent less blood supply and so more prone to injury and notorious healing outcomes. The management options for tendoachilles injury depend on the location of the tear, degree of retraction of the torn ends, and patient-related factors. Intraosseous lipoma is very rare benign tumor of bone accounting for 0.1% of all bone tumors. Most common site being proximal femur involvement of calcaneum is very rare presentation. Symptomatic patients with significant heel pain need operative intervention in the form of curettage alone or in combination with filling cavity with bone graft or bone graft substitutes. Many people use PMMA bone cement to fill the void. Case Report: A 65-year-old male presented with chronic heal pain and difficulty in walking. On clinical examination and radiological investigation, calcaneal intraosseous lipoma was confirmed along with insertional tendinopathy of tendoachilles and haglund syndrome causing tear at insertion into calcaneal tuberosity. We managed this patient in single-stage surgery using tendoachilles split approach for removing haglund deformity and double row anchor suturing for tendon reattachment. Repair was augmented with flexor hallucis longus (FHL) graft fixed using interference screw in the calcaneum. Lipoma was approached with separate medial approach. Cortical window created, lipoma curettage was done, and cavity filled with hydroxyapatite bone graft substitute. Conclusion: Tendoachilles split approach with double row suture anchor repair along with FHL graft gives good clinical outcome in insertional tendinopathy of tendoachilles with haglund syndrome. Curettage of intraosseous lipoma with filling the void using bone graft substitute such as hydroxyapatite gives good results and pain relief.