Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis

Poutoglidou, Frideriki; Drummond, Isabella; Patel, Amit; Malagelada, Francesc; Jeyaseelan, Luckshmana; Parker, Lee

doi:10.1016/j.fas.2023.04.007

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…Previous reviews have also analyzed the complication rate of ZO for the treatment of IAT. Poutoglidou et al 32 found an overall complication rate of 9.48% for ZO, but grouped percutaneous and open procedures together in this analysis. Black et al 3 also grouped all percutaneous and open ZO cases together, and found a complication rate of 10%.…”

Section: Discussionmentioning

confidence: 96%

“…20,27 IAT often coexists with retrocalcaneal bursitis and Haglund’s deformity (a posterosuperior bony grown of the calcaneus), comprising the Haglund’s syndrome triad. 32 Primary treatment of IAT is nonoperative; management includes eccentric Achilles-strengthening exercise, nonsteroidal anti-inflammatories, orthotics, and shoe wear modification. 46 However, 20% to 40% of patients will fail to improve with these more conservative treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Complication rates have ranged from 3.1% to 16.7%. 1,3,32,42 However, to our knowledge, no prior review has analyzed and compared the clinical outcomes between percutaneous and open approaches for ZO. The aim of this systematic review was to better inform surgeons’ evidence-based guidelines, and patient expectations, when selecting between the percutaneous vs open ZO.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this systematic review was to better inform surgeons’ evidence-based guidelines, and patient expectations, when selecting between the percutaneous vs open ZO. 1,3,32,42…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review

Bakaes,

Hall,

Jackson

et al. 2024

Foot & Ankle Orthopaedics

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Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund’s deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The aim of this systematic review was to better inform surgeons’ evidence-based guidelines, and patient expectations, when selecting between the percutaneous vs open ZO. 1,3,32,42…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review

Bakaes,

Hall,

Jackson

et al. 2024

Foot & Ankle Orthopaedics

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“…Nevertheless, as DCWCO shortens the calcaneus, triceps surae lever arm and functional length are inevitably reduced, which may impair plantar flexion strength, 9,15 and in turn walking function. However, because previously reported results are essentially based on patient-reported outcome measures, 20 no scientific evidence about the functional consequences of DCWCO on ankle muscle strength and gait function is available. Therefore, the main aim of this observational prospective cohort study was to analyze the influence of DCWCO on plantar flexor (and dorsiflexor) muscle strength and gait kinematics and kinetics in patients with Haglund exostosis-related heel pain by comparing the involved to the uninvolved limb before and 1 year after surgery.…”

Section: Introductionmentioning

confidence: 99%

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain

Friesenbichler,

Rutishauser,

Rippstein

et al. 2024

Foot Ankle Int.

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Background: Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. Methods: Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. Results: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome). Conclusion: In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. Level of Evidence: Level II, observational prospective cohort study.

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Outcomes of Revision surgery for surgically treated insertional Achilles tendinopathy

Hörterer,

Oppelt,

Pfahl

et al. 2024

Arch Orthop Trauma Surg

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Introduction There is a clear roadmap for the treatment of primary insertional Achilles tendinopathy (IAT), but data on the outcome of revision surgery is missing. The current study aimed to analyze the outcome following revision surgery for surgically failed IAT. Material and methods Included were patients with IAT revision surgery at a single reference center (01/2010–10/2016) and a follow-up of at least 12 months. Revision surgery was performed, whenever possible, through a midline incision transachillary approach (MITA) with debridement of all pathologies present. The patient-rated outcome was assessed per the FFI (preoperative, final follow-up) and VISA-A-G (final follow-up). The aim was to evaluate the patient rated outcome following revision surgery for recurrent IAT. Results Out of 24 eligible patients, 19 (79%) were included in the final follow-up. The mean follow-up duration was 4.6 ± 2.2 years. The FFI Overall improved from preoperatively 68 ± 19 to 14 ± 17 points (< 0.001) at the final follow-up. The final VISA-A-G was 71 ± 28 points. 39%/36% (FFI/VISA-A-G) of patients reached patient-rated outcome scores comparable to a healthy reference population. No factors could be identified to influence the outcome significantly. Conclusion IAT revision surgery results in an improvement of the patients’ symptoms, but only one-third of the patients recover fully.

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Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis

Cited by 11 publications

References 32 publications

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain

Outcomes of Revision surgery for surgically treated insertional Achilles tendinopathy

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