SLR - July 2023 - Ben M. Tonsager, DPM
Title: Fluoroscopic and Endoscopic Calcaneal Exostosis Resection and Achilles Tendon Debridement for Insertional Achilles Tendinopathy Results in Good Outcomes, Early Return to Sports Activities, and Few Wound ComplicationsReference: Nakajima K. Fluoroscopic and Endoscopic Calcaneal Exostosis Resection and Achilles Tendon Debridement for Insertional Achilles Tendinopathy Results in Good Outcomes, Early Return to Sports Activities, and Few Wound Complications. Arthrosc Sports Med Rehabil. 2022 Jun 9;4(4)
Level of Evidence: 4- Case Series
Scientific Literature Review
Reviewed By: Ben M. Tonsager, DPM
Residency Program: Regions Hospital, Saint Paul Minnesota
Podiatric Relevance:
Insertional Achilles tendinopathy is a condition often seen in Foot and Ankle surgery clinics. Conservative treatment can be effective in some circumstances; however, may be less effective when there is severe degeneration involved as well. Surgical treatments include a variety of incision approaches with calcaneal exostosis resection, Achilles tendon debridement, and resection of Haglund deformity with subsequent reattachment of distal Achilles tendon. While there are multiple documented studies about these various approaches having good surgical outcomes, there are also studies documenting wound complications, scar sensitivity, delayed healing, and delayed return to normal activities or sports. The purpose of this study was to review outcomes of patients with insertional Achilles tendinopathy who underwent fluoroscopic and endoscopic calcaneal exostosis resection with Achilles tendon debridement. They hypothesized that minimally invasive surgery result in good outcomes, earlier return to activities, and fever wound complications.
Methods:
A retrospective review was performed on patients from February 2017 to July 2019, after they had failed to respond to conservative treatments for more than 6 months. They required a minimum of 2-year follow-up. Fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement were the only procedures performed. Surgery was performed by a single surgeon. Preoperative 3D CT reconstruction and MRI utilized for pre-surgical planning. The Visual analog scale (VAS) and Japanese Society for Surgery of the Foot (JSSF) scores utilized for outcome measurements. VISA-A scores for patients participating in sporting activities.
Results:
Data analysis was conducted on a total of 44 patient's. The mean duration of follow-up was 2.8 (2.0-4.5) years. Overall, the VAS and JSSF scores improved and were highly statistically significant (P < .001). Of the 44 patients 22 of them participated in recreational sporting activities. Average time to return to sporting activities was 4.5 months. The VISA-A scores also showed a statistically significant improvement (P < .001). Five patients had moderate pain 1 year after primary surgery and opted for reoperation. This was believed to be caused by incomplete removal of exostosis and intra tendon ossification. After reoperation, all patient's achieved pain relief and outcomes were used for analysis. Lastly, two patients did have scar sensitivity, but no major wound healing complications.
Conclusions:
This study demonstrated and concluded that a minimally invasive surgery for the treatment of insertional Achilles tendinopathy can provide good surgical outcomes, early return to sport activities, and few wound complications. There was a statistically significant improvement in the VAS and JSSF scores for all patients as well as an improvement in the VISA-A score for those patients involved in sporting activities. In the right patient population, fluoroscopic and endoscopic calcaneal exostosis resection with Achilles tendon debridement would be a reliable treatment alternative in comparison to open procedure.