Lateral versus central tendon-splitting approach to insertional Achilles tendinopathy: a retrospective study

Abstract

This study aimed to compare operative outcomes between the lateral approach (LA) and the central approach (CA) to insertional Achilles tendinopathy (IAT). METHODS We retrospectively reviewed patients who underwent surgical treatment for IAT using the LA or CA. Patients' demographic data, postoperative complications and satisfaction rate were reviewed. Clinical outcomes were prospectively assessed preoperatively, at three months postoperatively and at the last visit, including patients' visual analogue scale (VAS) scores for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale scores and 36-item Short Form Health Survey (SF-36) scores. RESULTS There were 39 patients in the LA group and 32 in the CA group. In each group, average VAS and AOFAS Scale scores improved significantly. SF-36 scores improved in most parameters. No significant difference in baseline score; average AOFAS Scale score at each visit; and mean VAS score preoperatively and at last visit; satisfaction rate; and overall complication rate were observed between the groups. The mean VAS score in the LA group at postoperative three months was significantly lower than that in the CA group (2.7 ± 2.5 vs. 4.4 ± 3.0; p = 0.016). There were significantly more cases of delayed wound healing in the LA group than in the CA group (2.6% vs. 15.6%; p = 0.049). CONCLUSION Both approaches had comparable outcomes for IAT in terms of functional improvement, pain relief, overall enhancement of patients' health condition and overall postoperative complication rate. The LA provided better short-term pain relief and reduced delayed wound healing compared with the CA.

Functional Outcomes of Insertional Achilles Tendinopathy Treatment

“…The lateral approach provided better pain relief at 3 months, but there was no difference in function or pain at the time of final follow-up. The central-approach group had 5 patients with delayed wound-healing, significantly more than the 1 in the lateral-approach group (p = 0.049) 41 . The authors also reported no significant difference in sural nerve injury and credited the lack of nerve injury in the lateral approach to meticulous handling of soft tissue.…”

“…(p 5 0.049) 41 . The authors also reported no significant difference in sural nerve injury and credited the lack of nerve injury in the lateral approach to meticulous handling of soft tissue.…”

Lateral approach for insertional Achilles tendinitis with Haglund deformity

“…Lin et al (28) concluded that calcaneoplasty and reattachment of the Achilles tendon via a lateral approach for insertional tendinopathy enable early weight-bearing and achieve a good outcome and pain relief. Xia et al (29) reported the lateral approach provided better short-term pain relief and reduced delayed wound healing compared with the central approach, while other outcomes were comparable. In our series of 14 patients who underwent tendon detachment, debridement, and reattachment for IAT and were followed up for a mean of 14 months, the mean AOFAS ankle-hindfoot score improved from 67 to 90, the mean VAS score declined from 4.82 to 1.21, and the VISA-A score improved from 62 to 82.…”

ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

“…40,58,60,61,63,68,74,75,79,86,87,89,93,96,102,110,119,122,125,[132][133][134]138,142,[145][146][147][148]150,151,[153][154][155][158][159][160]165,166,169,171,173,181,185,186,188,189,193,198,204,212,223,226,…”