Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems

Abstract

Background: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. Results: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 ( P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% ( P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. Conclusion: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems Level of Evidence: Level III, retrospective study.

Association of Haglund Deformity Size and Insertional Achilles Tendinopathy

“…Traditionally, Haglund deformity resection requires an open procedure, but endoscopic/fluoroscopic minimally invasive procedures have become popular. 2,4,5,11,12,15,17,18,25 Furthermore, good clinical outcomes have been reported with the dorsal closing wedge calcaneal osteotomy combined with Haglund deformity removal. 2,7,8 However, the association between Haglund deformity and insertional Achilles tendinopathy is still debatable.…”

A Novel Approach to Haglund Deformity Resection Using a Percutaneous Ultrasound-Guided Osteotomy Device

“…Historically, endoscopic calcaneoplasty was reserved for Haglund deformity and retrocalcaneal bursitis without associated Achilles tendon degeneration or intratendinous calcifications, although newer endoscopic techniques have been reported with associated tendon debridement and repair of the tendon (6,(9)(10)(11)(12)(13). The main advantage of an endoscopic approach is that the procedure is minimally invasive with comparable results to open surgical treatment and with fewer complications (17,26).…”

“…In foot and ankle surgery, percutaneous procedures have been shown to reduce soft tissue damage, decrease the risk of wound infection, and allow quicker rehabilitation (31,32); however, the literature on percutaneous procedures for Haglund syndrome or insertional Achilles tendinopathy is limited (13)(14)(15)(16). New percutaneous techniques using ultrasound-assisted (15,16) or fluoroscopic-guided (13,14) calcaneoplasty and a single posteromedial portal have been described using a bone abrader (Smith & Nephew, Andover, MA) (15,16) or Shannon burr (Miltex Instrument, Rietheim-Weilheim, Germany) (13,14). Advantages of these newer percutaneous techniques include using a single posteromedial portal, that heoretically minimizes the risk of sural nerve injury (15,16).…”

“…Calcaneoplasty is a common procedure for Haglund syndrome after failed conservative management and traditional surgical options include open or endoscopic approaches (8)(9)(10)(11)(12). Percutaneous calcaneoplasty under fluoroscopic or ultrasonography-assisted percutaneous surgery using a bur or bone abrader have been reported, but the literature on percutaneous procedures for Haglund syndrome or insertional Achilles tendinopathy is limited (13)(14)(15)(16). Current percutaneous treatment options appear to be reliable and effective, but the published techniques are unable to address pain generators within the Achilles tendon.…”

Minimally invasive surgeries for insertional Achilles tendinopathy: A commentary review

“…Lui[ 67 ] reported that endoscopy in the supine position allowed for easier identification of anatomical structures than in the prone position[ 67 ]. Ferranti et al [ 68 ] reported that in 27 patients who underwent percutaneous posterosuperior prominence resection, the mean VISA-A score improved from 20 preoperatively to 75 postoperatively, and 84% experienced complete satisfaction[ 68 ].…”