Reconstruction of concurrent chronic insertional Achilles tendinosis and chronic midsubstance Achilles tendinosis with Haglund deformity: A case report

Abstract

Achilles tendinopathy affects athletes at all levels. While tendinopathy is usually found in either the midsubstance or the Achilles insertion, it is rarely seen in both areas of the tendon concomitantly. We report on a rare case of bilateral chronic insertional Achilles tendinosis and chronic midsubstance Achilles tendinosis with Haglund deformity treated with central tendon debridement, flexor hallucis longus (FHL) transfer, Haglund resection, and reattachment of the Achilles insertion using the Arthrex Speedbridge ® system. To our knowledge, this case report is the first for the treatment of combined midsubstance and insertional Achilles tendinosis. Our method allows us to reapproximate the Achilles to its normal anatomy while eliminating the need for bulky suture knots and simultaneously giving an excellent clinical result.

Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient

“…They reported that 42 of 43 patients returned to their activities of daily living, including running in 20 athletic patients (100%). Other reports also demonstrated the efficacy of this new technique (4,6). In a biomechanical study, Pilson et al reported that they did not find a statistically significant difference in the peak load to failure between the conventional suture…”

“…insertion securely fixed the tendon to the prepared bony surface. The interference screw fixation eliminated the need for a series of bulky knots at the repair site (6). Then, simple interrupted sutures with 4-0 PDS were used to approximate the incised area of the Achilles tendon and paratenon.…”

“…anchor technique and this new suture bridge technique (14). Macias et al (6) mentioned that the use of the conventional suture anchor technique typically left behind prominent knots that were frequently bothersome to patients. Further, they suggested that the suture bridge technique allowed surgeons to more precisely approximate the Achilles footprint and eliminated the need for bulky suture knots that could cause heel pain or discomfort with footwear.…”