Severe insertional Achilles tendinopathy. Our experience with two different surgical techniques: surgical debridement and dorsal closing wedge calcaneal osteotomy according to modified Zadek’s technique

• Published in: Chirurgia Narządów Ruchu i Ortopedia Polska 2022-12, Vol.87 (4), p.148-152
• Main Authors: Kucharski, Robert Adam, Abiddin, Zain, Ahmad, Kashif, Munoruth, Ashveen, Maheshwari, Rajan
• Format: Article
• Language: English
• ISSN: 0009-479X
• DOI: 10.31139/chnriop.2022.87.4.2

Introduction. This study is a retrospective analysis of two cohorts of patients treated for severe insertional Achilles tendinopathy (IAT) with two different surgical methods: surgical debridement and dorsal closing wedge calcaneal osteotomy according to modified Zadek’s technique. Materials and methods. We treated a total of 36 feet in 35 patients. Twenty five patients had surgical excision of intra-tendinous calcification with excision of posterior calcaneal prominence and reinforcement of insertion with either suture anchors or fibre tape. Ten patients (11 feet) had modified Zadek’s calcaneal osteotomy as an isolated intervention, without any other procedure to the Achilles tendon insertion or to the posterior part of the calcaneus. The mean age at operation was 52.6 years. (Range: 31 to 68 years in the debridement group and 18 to 64 years in the osteotomy group). There were 17 males and 18 females. 20 were right-sided procedures. Mean follow-up in the outpatient clinic for a clinical examination was 20 weeks. We expanded observation period with an up-to-date score based on Victoria Institute of Sport Assessment-Achilles Tendon (VISA-A) questionnaire and Manchester Oxford Foot Questionnaire (MOXFQ) making the maximum follow up in the debridement group up to 8 years and the osteotomy group of 4 years. Results. The open debridement group showed 76% (19 patients) to have a good to excellent outcome. The calcaneal osteotomy group showed 82% (9 patients) to have a good to excellent outcome. Osteotomies were united in all patients. We had no complications in either group until discharge. Conclusions. Both methods showed to be safe and efficient in bringing symptomatic relief to patients in short, medium and long-term observation.