Insertional Achilles Tendinosis: Surgical Treatment Through a Central Tendon Splitting Approach

McGarvey, William C.; Palumbo, Robert C.; Baxter, Donald E.; Leibman, Bryan D.

doi:10.1177/107110070202300104

Cited by 193 publications

(197 citation statements)

References 25 publications

Supporting

Mentioning

191

Contrasting

Unclassified

Order By: Relevance

“…26 Surgery is costly in terms of financial resources, time off work due to weight-bearing restrictions, and risk of complications. 15,24 Moreover, even a year after surgery, many patients continue to report some pain and functional limitations. 15,24 Despite the severity and chronicity of this problem, there is little research to guide the development of new physical therapy interventions for IAT.…”

mentioning

confidence: 99%

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Chimenti¹,

Flemister²,

Tome³

et al. 2014

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

A cross-sectional image was obtained 2 cm proximal to the tendon insertion. Echogenicity was quantified as the mean grayscale value for the central 1 cm of the entire depth of the tendon cross-section (FIGURES 1C and 1D). The grayscale value for a pixel could range from 0 (black) to 255 (white). The mean grayscale value for all pixels in the region of interest was quantified using ImageJ, with a lower value indicating greater pathology. All ultrasound images had the same gain setting of 56 and were collected at a 3-cm depth, so that differences in ultrasound settings would not influence the mean grayscale values between participants. Tendon Mechanical PropertiesThe combination of ultrasound imaging and dynamometry was used to measure tendon mechanical properties (strain, stiffness). Each participant's ankle was positioned and secured in a Biodex System 4 (Biodex Medical Systems, Inc, Shirley, NY) in sitting, with the seatback reclined to 45°, the chair height adjusted so that the tibia was parallel to the floor, and the hip in neutral adduction/abduction (FIGURE 2A). The participant's ankle was moved in the sagittal plane from 10° of plantar flexion to 10° of dorsiflexion at a rate of 5°/s, and the passive plantar flexion torque was recorded at a rate of 1000 Hz. Similar to previous studies, 5,8,18 ultrasound imaging was used to track the linear displacement of the gastrocnemius muscle-Achilles tendon junction (MTJ), with the probe at a fixed point on the calf (FIGURES 2B and 2C). A first set of 6 rotations was used for preconditioning, followed by a second set of 6 rotations, from which images were used to calculate tendon mechanical properties. B-mode ultrasound images were collected when the ankle was in (1) 10° of plantar flexion at the start and end of the second set and (2) 10° of dorsiflexion during the third, fourth, and fifth repetitions. The location of the MTJ in each ankle position was averaged, so that distance between the MTJ locations in 10° of plantar flexion and 10° of dorsiflexion could be calculated. A video was taken on the second repetition to confirm that the images captured the full range of MTJ displacement. Passive torque values from the third, fourth, and fifth repetitions of the second set were used for analysis. Participants were instructed to relax as the foot plate moved the ankle. To ensure that the condition was passive, the activity of the medial gastrocnemius and the anterior tibialis muscles was monitored by a 2-channel Bagnoli desktop electromyography system (Delsys Inc, Natick, MA). Single-differential surface electrodes (input impedance greater than 1015 Ω // 0.2 pF; common-mode rejection ratio, -92 dB; noise, 1.2 μV; preamplifier gain, 10 V/V  1%) were used. The contact material was 99.9% Ag, in the shape of 2 bars with contact dimensions of 10 × 1 mm and spaced 1 cm apart. The electrodes were placed over the motor point of the medial gastrocnemius and the anterior tibialis muscles. The raw electromyography signal was viewed using a 2-channel digitizing oscilloscope (Tektr...

show abstract

mentioning

confidence: 99%

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Chimenti¹,

Flemister²,

Tome³

et al. 2014

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

show abstract

“…Post operatively the patients were evaluated using ankle and foot scale. [10] The pre-operative score varied from 37 to 43 points with an average of 41 points and postoperatively the score varied from 81 to 83 points with an average of 82 points. Out of 25 patients 20 patients had complete relief of symptoms by three months.…”

Section: Materials and Methodmentioning

confidence: 99%

Surgical Management of Refra Ctory Retro - Calcaneal Bursitis Evaluation of Its Results

K¹,

Ravikumar²,

Sujai³

et al. 2015

jemds

View full text Add to dashboard Cite

CONTEXT: Heel pain is common in middle and elderly people due various causes. BACKGROUND: Retrocalcaneal bursitis may not respond for medical treatment and may need surgery for relief of pain. AIM: To study the results of surgical treatment in Retrocalcaneal bursitis. MATERIALS AND METHODS:The patients with refractory retrocalcaneal bursitis were taken up for the study. inclusion criteria is pain, swelling over postero superior aspect of the heel not responding to conservative treatment like heat, analgesics and local steroids. The only contraindication was uncontrolled diabetes. X-ray of heel lateral view was taken in all patients and prominence of posterio superior part was assessed. Pre and postoperatively the foot were assessed hy Ankle and foot scale. Through lateral incision the prominent bony prominence and retrocalcaneal bursa was excised. RESULTS: 25 patients with refractory retrocalcaneal bursitis underwent surgery. 15 males and 10 females with mean age of 46 years and mean duration for symptioms of one year and eight months and mean fallow up period of one year and one month. The pre-operative ankle and foot scale score was 37 to 43 points with a median of 41 points. Post-operative score was 76 to 83 with a median of 81 points. 20 patients (80%) had complete relief of symptoms. Four patents (16%) had minimal pain after long walking. One patient had moderate pain restricting his daily activities (4%). CONCLUSIONS: surgical excision of prominent spur along with retrocalcaneal bursa gives good result.

show abstract

“…Mc Garvey et al reported improvement in 89% of their cases treated with conservative measures. 5 In patients where conservative methods fail, surgery may be indicated. Several methods have been described including excision of the retrocalcaneal bursa, calcaneal osteotomy, and calcaneal osteotomy with Achilles tendon debridement.…”

Section: Introductionmentioning

confidence: 99%

Surgical resection of Haglund deformity by lateral approach: our institutional experience on 29 heels

Mir

Ali²,

Khan

et al. 2018

Int J Res Orthop

View full text Add to dashboard Cite

Background: Haglund deformity is a common cause of posterior heel pain and consists of a constellation of soft tissue and osseous abnormalities. The treatment starts with conservative approach and ends with surgical treatment in case conservative treatment fails and the symptoms are bothersome. Different surgical procedures and approaches have been used for this deformity. But in the literature, the results have been inconsistent. In this study we evaluated the clinical and functional outcome of osteotomy of the calcaneal tuberosity with debridement of the retrocalcaneal bursa and the Achilles tendon using a lateral approach at our institute.Methods: A total of 29 feet in 25 patients that underwent surgical procedure from August 2013 to March 2017 at our institute were included in this study. The clinical and functional outcome was evaluated using AOFAS ankle-hind foot scale.Results: The mean AOFAS ankle-hind foot score had improved by 32 points from the pre-operative mean score, with a mean score of 86 at the final follow up of one year. Five out of 29 operated feet had superficial surgical site infection in the postoperative period that responded to antibiotic therapy and regular antiseptic dressings. One patient had local betadine allergy.Conclusions: We conclude lateral approach to debridement and calcaneal tuberosity resection is an effective method with good clinical and functional outcome in patients with refractory Haglund deformity.

show abstract

Insertional Achilles Tendinosis: Surgical Treatment Through a Central Tendon Splitting Approach

Cited by 193 publications

References 25 publications

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Surgical Management of Refra Ctory Retro - Calcaneal Bursitis Evaluation of Its Results

Surgical resection of Haglund deformity by lateral approach: our institutional experience on 29 heels

Contact Info

Product

Resources

About