Treatment of Achilles insertional calcific tendinosis using a longitudinal midline incision approach/central tendon splitting approach

• Published in: Operative Orthopädie und Traumatologie 2022-12, Vol.34 (6), p.405-418
• Main Authors: Arbab, Dariusch, Bouillon, Bertil, Lüring, Christian, Gutteck, Natalia, Lipphaus, Andreas, Lichte, Philipp
• Format: Article
• Language: ger
• Subjects: Humans; Tendinopathy - surgery; Treatment Outcome
• ISSN: 1439-0981
• DOI: 10.1007/s00064-022-00793-4

Treatment of Achilles insertional calcific tendinosis through a longitudinal midline incision approach with optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity). Calcific Achilles tendinosis, dorsal heel spur, insertional tendinosis. General medical contraindications to surgical interventions. Fracture, infection. Longitudinal skin incision medial of the Achilles tendon. Exposure and midline incision of the Achilles tendon with plantar detachment from the insertion site preserving medial and lateral attachment. Resection of a dorsal heel spur and intratendinous calcifications. Optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity). Partial weight bearing 20 kg in 30° plantar flexion in a long walker boot for 2 weeks. Afterwards 2 weeks of progressively weight bearing in 15° plantar flexion and another 2 weeks in neutral ankle joint position in a long walker boot. A total of 26 feet of 26 patients with calcific Achilles tendinosis were treated with midline incision of the tendon. In all feet calcific tendon parts were resected. In 10 (38%) feet, a prominent dorsal spur was resected, in 12 feet (38%) retrocalcaneal bursa, and in 24 (92%) feet a calcaneal tuberosity. Mean follow-up was 34.5 months (range 2-64 months). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 58.2 (±8.1) and postoperatively the score was 22.75 (±6.0). In all, 7 (26.9%) patients stated delayed wound healing; 1 suffered from deep vein thrombosis. Shoe problems were reported by 50% of patients, and 23.1% suffered from par- or dysesthesia. No revision surgery was required.