Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy

Tallerico, Valerie K.; Greenhagen, Robert M.; Lowery, Clinton

doi:10.1177/1938640014557077

Cited by 33 publications

(29 citation statements)

References 19 publications

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“…Attention must be paid to avoid transection of the sural nerve, and the release must be always performed under direct visualisation. A single surgeon series on 11 patients showed promising results in terms of AOFAS score and pain, achieving a 91% satisfaction rate 24. Another series of nine patients treated with open approach presented good outcomes, with a superiority of results for those with IAT, compared with those with non-insertional pathology 61…”

Section: Management Of Iatmentioning

confidence: 99%

Achilles insertional tendinopathy: state of the art

Maffulli

Saxena²,

Wagner

et al. 2019

Journal of ISAKOS

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Section: Management Of Iatmentioning

confidence: 99%

Achilles insertional tendinopathy: state of the art

Maffulli

Saxena²,

Wagner

et al. 2019

Journal of ISAKOS

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“…1, 2 However, other interventions that do not remove osteophytes, such as isolated gastrocnemius recession, are also effective. 3 To better inform theory driving operative management, research is needed to examine the association of osteophytes and IAT.…”

mentioning

confidence: 99%

Utility of Ultrasound for Imaging Osteophytes in Patients With Insertional Achilles Tendinopathy

Chimenti

Buckley

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objective To examine 1) the validity of ultrasound imaging to measure osteophytes, and 2) the association between osteophytes and IAT. Design Case-control study Setting Academic medical center Participants 20 persons with chronic unilateral IAT (Age: 58.7 ± 8.3 years, 50% female) and 20 age- and gender-matched controls (Age: 57.4 ± 9.8 years, 50% female) participated in this case-control study. Intervention Not applicable. Main Outcome Measures Symptoms severity was assessed using the Foot and Ankle Ability Measure (FAAM), Victorian Institute of Sport Assessment- Achilles questionnaire (VISA-A), and the Numerical Rating Scale (NRS). Length of osteophytes was measured bilaterally in both groups using ultrasound imaging and additionally on the symptomatic side of the IAT group using radiographs. The intraclass correlation coefficient was used to examine the agreement between ultrasound and radiograph measures. McNemar, Wilcoxon Signed Rank and Fisher’s exact tests were used to compare the frequency and length of osteophytes between sides and groups. Pearson correlation was used to examine the association between osteophyte length and symptom severity. Results There was good agreement (ICC ≥0.75) between ultrasound and radiograph osteophyte measures. There were no statistically significant differences (P>0.05) between sides or groups in the frequency of osteophytes. Osteophytes were larger on the symptomatic side of the IAT group compared to the asymptomatic side (P= 0.01) and controls (P=0.03). There were no associations between osteophyte length and symptom severity. Conclusions Ultrasound imaging is a valid measure of osteophyte length, which is associated with IAT. While a larger osteophyte indicates pathology, it does not indicate more severe IAT symptom severity.

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“…[2][3][4] However, when there is major intratendinous bone pathology involved, in clinical practice surgery is often warranted. Surgical techniques [5][6][7][8][9][10][11][12][13][14][15][16][17][18] include procedures such as tendon detachment-bone removal-tendon re-attachment and calcaneo-osteotomy. Bone removal via longitudinal tenotomy is an alternative when there is minor bone pathology.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

Alfredson

Spang

2020

BMJ Open Sport Exerc Med

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BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

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Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy

Abstract: Therapeutic, Level IV: Case series.

Cited by 33 publications

References 19 publications

Achilles insertional tendinopathy: state of the art

Achilles insertional tendinopathy: state of the art

Utility of Ultrasound for Imaging Osteophytes in Patients With Insertional Achilles Tendinopathy

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

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