Technique and Results of Achilles Tendon Detachment and Reconstruction for Insertional Achilles Tendinosis

Abstract

Background: Insertional Achilles tendinosis is a clinical entity that commonly occurs with other posterior heel disorders such as retrocalcaneal bursitis, Haglund deformity, intratendinous ossification and pretendinous bursitis. Complete detachment and reconstruction of the Achilles tendon was evaluated as a method of treatment for this condition. Methods: Seventyfive patients (81 heels) were treated over a 5-year period for chronic insertional Achilles tendinosis. These were divided in two groups: a nondetached group (26 patients, 31 heels, average age 55 years) included all patients with debridement of the Achilles tendon with no or partial detachment of the tendon, and a detached group (49 patients, 50 heels, average age 56.1 years) that included all patients with complete detachment, debridement, and reattachment with suture anchors of the Achilles tendon associated with proximal V-Y lengthening of the proximal aponeurosis. Sixty-one patients (65 heels) were contacted for an interview questionnaire, 22 patients from the nondetached group (26 heels) and 39 patients from the detached group (39 heels). The average followup for the nondetached group was 47 months and for the detached group 33 months. Items evaluated included pain, activity limitation, gait change, walking distance, return to sport or work, and level of satisfaction. Results: No statistically significant differences were noted in relation to any of the items evaluated. In the nondetached group, the satisfaction rate was 92%, and 8% were dissatisfied. In the detached group, 74% were completely satisfied and 18% were satisfied with reservations. Eight percent were dissatisfied. Complications included minor wound dehiscence (one in the nondetached, five in the detached group), wound infection (one in the nondetached group, two in the detached group)

Safety of Achilles Detachment and Reattachment Using a Standard Midline Approach to Insertional Enthesophytes

“…Overall, the complication rates throughout the published studies of this procedure have varied from 4.7% to 41% (16). Some investigators have suggested that the most common reason for postoperative Achilles avulsion, and ultimately, reoperation is due to falls (13,14,17). In our retrospective study, we saw only 4.0% (4 of 99) of insertional Achilles repeat ruptures, and of these, 3 (75.0%) of the 4 had resulted from falls in the early postoperative period.…”

“…Wagner et al (13) described a slightly more medial incision, comparing partial detachment and complete Achilles detachment for retrocalcaneal decompression, along with a proximal V-Y aponeurotic lengthening. In their retrospective analysis, 75 patients were divided into 2 groups, 26 and 49, respectively.…”

“…No patients developed an Achilles rupture within the long-term follow-up period. The published data have reported other postoperative complications such as avulsions related to falls or tripping but at a low overall rate of 11% (12)(13)(14). The aim of the present investigation was to calculate the incidence of complications associated with detachment of the Achilles tendon using a midline incisional approach for the treatment of insertional tendinitis.…”

Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

“…Many studies evaluate various forms of surgery to treat Achilles tendinopathy [92,102,109,122,139,151,191]. The approaches vary greatly between studies based partly on the extent of abnormality.…”

Button Fixation Technique for Achilles Tendon Reinsertion: A Biomechanical Study

“…Additional clinical trials are needed to confirm the effectiveness of recession alone. However, few studies have compared the method of reattachment or fixation of the Achilles tendon, and present practice has left this decision to the discretion of the surgeon (4,6).…”