Surgical Strategies: Insertional Achilles Tendinopathy

DeOrio, Matthew; Easley, Mark E.

doi:10.3113/fai.2008.0542

Cited by 57 publications

(41 citation statements)

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“…The operative strategy for insertional Achilles tendinopathy is removal of the degenerative tendon and associated calcification, excision of the inflamed retrocalcaneal bursa, resection of the prominent posterior calcaneal prominence, reattachment of the insertion as required, and/or augmentation of the tendo-Achilles with a tendon transfer/graft [101, 102]. Calcaneoplasty and resection of the retrocalcaneal bursa can be performed endoscopically [102].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…When greater than 50% of the Achilles tendon is detached from the calcaneus, suture anchors are recommended to reattach the residual tendon. With extensive insertional, Achilles tendon disease and/or when greater than 75% of the tendon is excised, augmentation with local tissue, such as the flexor hallucis longus tendon and semitendinosus tendon, is advisable [102]. …”

Section: Surgical Treatmentmentioning

confidence: 99%

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Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Liu

Hua

2016

BioMed Research International

141

120

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Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Liu

Hua

2016

BioMed Research International

141

120

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“…Insertional Achilles tendinopathy is typically associated with a prominent posterosuperior calcaneal tuberosity (Haglund's prominence) and/or radiographically apparent calcification at the tendon's insertion that is the tendinopathy chronic stage [14] . Although the Achilles tendon experiences such high mechanical loads, the tendon exhibits biomechanical properties that are similar to those of other tendons, increasing the risk for failure and injury [2] .…”

Section: Introductionmentioning

confidence: 99%

The Achilles Tendinopathy: Pathogenesis Review

Bondi¹,

Rossi²,

Magnan³

et al. 2015

International Journal of Orthopaedics

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Achilles tendinopathy is a degenerative disease with high prevalence in runners. For the comprehension of achilles tendinopathy we have to consider intrinsic conditions such as age, sex, BMI, tendon temperature, systemic diseases, flexibility, previous injuries and anatomical variations, genetic predisposition and blood supply and extrinsic factors such as drugs and overuse. Both categories can be responsible for development of achilles' degenerative tendinopathy. Different hypothesis were studied, those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis.

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“…In our surgical procedure a longitudinal lateral skin incision in the Achilles tendon insertion was used, which is one of several approaches previously described [16][17][18][19][28][29][30]. The lateral incision provided good access to the distal part of the tendon, the subcutaneous-and retrocalcaneal bursa, and the upper calcaneus.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound and Color Doppler-Guided Surgery for Insertional Achilles Tendinopathy-Results of a Pilot Study

Alfredson

Isaksson²

2014

OJO

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Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund's deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p < 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.

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Surgical Strategies: Insertional Achilles Tendinopathy

Cited by 57 publications

References 0 publications

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

The Achilles Tendinopathy: Pathogenesis Review

Ultrasound and Color Doppler-Guided Surgery for Insertional Achilles Tendinopathy-Results of a Pilot Study

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