Bony resection and suture anchor repair in haglund deformity with insertional achilles tendinopathy

Authors

  • Ihsan Oesman Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Rizki Hidayat Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia

Keywords:

Achilles tendinopathy, insertional Achilles tendinopathy, Haglund deformity, bony resection, suture anchor

Abstract

Introduction:

Achilles tendinopathy is a combination of pain, swelling, and impaired performance due to Achilles tendon condition. Chronic case of this disease mostly failed with conservative treatment, however, operative approach will improve the function of the Achilles tendon.

Methods:

We report an elderly patient with Achilles tendinopathy, who clinically had Haglund deformity and insertional Achilles tendinopathy. The patient had failed nonoperative treatment and undergone surgery with calcaneal osteotomy and Achilles tendon repair using suture anchor.

Results:

The primary goal of the surgery in Achilles tendinopathy was correction of the deformity and thorough debridement at the site of inflammation. The Haglund deformity can be corrected with posterior calcaneal osteotomy and calcification at the Achilles insertion must be removed. Because the site of calcification was at the distal end of the Achilles tendon, suture anchor repair was the best choice to get stable fixation of the tendon.

Conclusion :

Bony resection for Haglund deformity and debridement and suture anchor repair for the insertional Achilles tendinopathy are effective surgical treatments for Achilles tendinopathy

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References

Myerson MS, McGarvey W. Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect. 1999;48:211–8.

Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, D?nmez G, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):638–43.

Syha R, Springer F, Ketelsen D, Ipach I, Kramer U, Horger M, et al. Achillodynia - radiological imaging of acute and chronic overuse injuries of the achilles tendon. Bony resection and suture anchor repair in haglund deformity with insertional achilles tendinopathy ROFO Fortschr Geb Rontgenstr Nuklearmed. 2013 Nov;185(11):1041–55.

Riley G. The pathogenesis of tendinopathy. A molecular perspective. Rheumatol Oxf Engl. 2004 Feb;43(2):131– 42.

Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999 Jul;81(7):1019–36.

White DW, Wenke JC, Mosely DS, Mountcastle SB, Basamania CJ. Incidence of major tendon ruptures and anterior cruciate ligament tears in US Army soldiers. Am J Sports Med. 2007 Aug;35(8):1308–14.

Hess GW. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec. 2010 Feb;3(1):29–32.

Saltzman CL, Tearse DS. Achilles tendon injuries. J Am Acad Orthop Surg. 1998 Oct;6(5):316–25.

Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002 Apr;30(2):287–305.

Reddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KL. Surgical treatment for chronic disease and disorders of the achilles tendon. J Am Acad Orthop Surg. 2009 Jan;17(1):3–14.

Battery L, Maffulli N. Inflammation in overuse tendon injuries. Sports Med Arthrosc Rev. 2011 Sep;19(3):213–7.

McGarvey WC, Palumbo RC, Baxter DE, Leibman BD. Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int. 2002 Jan;23(1):19–25.

Di Matteo B, Filardo G, Kon E, Marcacci M. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review. Musculoskelet Surg. 2015 Apr;99(1):1–9.

de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144–9.

Ortmann FW, McBryde AM. Endoscopic bony and softtissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int. 2007 Feb;28(2):149–53.

Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. 1984 Jun;12(3):179–84.

Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015 Mar;43(3):752–61.

Kader D. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002 Aug 1;36(4):239–49.

Steenstra F, van Dijk CN. Achilles tendoscopy. Foot Ankle Clin. 2006 Jun;11(2):429–438, viii.

O’Brien M. Functional anatomy and physiology of tendons. Clin Sports Med. 1992 Jul;11(3):505–20.

Chen TM, Rozen WM, Pan W-R, Ashton MW, Richardson MD, Taylor GI. The arterial anatomy of the Achilles tendon: anatomical study and clinical implications. Clin Anat N Y N. 2009 Apr;22(3):377–85.

Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (’entheses’) in relation to exercise and/or mechanical load. J Anat. 2006 Apr;208(4):471–90.

Maffulli N, Longo UG, Ronga M, Khanna A, Denaro V. Favorable outcome of percutaneous repair of achilles tendon ruptures in the elderly. Clin Orthop. 2010 Apr;468(4):1039–46.

Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80(2):188–201.

Kannus P, Niittymäki S, Järvinen M, Lehto M. Sports injuries in elderly athletes: a three-year prospective, controlled study. Age Ageing. 1989 Jul;18(4):263–70.

Dirix A, Knuttgen HG, Tittel K, International Olympic Committee, International Federation of Sports Medicine,

editors. The Olympic book of sports medicine. Pbk. reissue. Oxford ; Boston : St. Louis, Mo: Blackwell Scientific Publications ; Distributors, USA, Mosby-Year Book; 1991. 692 p. (Encyclopaedia of sports medicine).

Paterno MV, Taylor-Haas JA, Myer GD, Hewett TE. Prevention of Overuse Sports Injuries in the Young Athlete. Orthop Clin North Am. 2013 Oct;44(4):553–64.

Khan KM. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med. 2000 Apr 1;34(2):81–3.

Khan KM, Cook JL. Overuse Tendon Injuries:: Where Does the Pain Come From? Sports Med Arthrosc Rev. 2000 Jan;8(1):17–31.

Leppilahti J, Orava S, Karpakka J, Takala T. Overuse injuries of the Achilles tendon. Ann Chir Gynaecol. 1991;80(2):202–7.

Galloway MT, Jokl P, Dayton OW. Achilles tendon overuse injuries. Clin Sports Med. 1992 Oct;11(4):771– 82.

Natarajan S, Narayanan V. Haglund Deformity ? Surgical Resection by the Lateral Approach. Malays Orthop J. 2015 Mar 1;9(1):1–3.

Movin T, Gad A, Reinholt FP, Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand. 1997 Apr;68(2):170–5.

Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med Auckl NZ. 2000 Feb;29(2):135–46.

Hess GP, Cappiello WL, Poole RM, Hunter SC. Prevention and treatment of overuse tendon injuries. Sports Med Auckl NZ. 1989 Dec;8(6):371–84.

Morrissey D, Roskilly A, Twycross-Lewis R, Isinkaye T, Screen H, Woledge R, et al. The effect of eccentric and concentric calf muscle training on Achilles tendon stiffness. Clin Rehabil. 2011 Mar 1;25(3):238–47.

Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001

Jan;9(1):42–7.

Jerosch J, Schunck J, Sokkar SH. Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2007 Jul;15(7):927–34.

Roche AJ, Calder JDF. Achilles tendinopathy: A review of the current concepts of treatment. Bone Jt J. 2013 Oct 1;95–B(10):1299–307.

Paavola M, Kannus P, Järvinen TAH, Khan K, Józsa L, Järvinen M. Achilles tendinopathy. J Bone Joint Surg Am. 2002 Nov;84–A(11):2062 76.

Pilson H, Brown P, Stitzel J, Scott A. Single-row versus double-row repair of the distal Achilles tendon: a biomechanical comparison. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2012 Dec;51(6):762–6.

Nunley JA, Ruskin G, Horst F. Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int. 2011 Sep;32(9):850–5. 48 Bony resection and suture anchor repair in haglund deformity with insertional achilles tendinopathy

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Published

2018-04-20