Does central-splitting or complete detachment provide better clinical results in surgical treatment of Haglund's disease? A 2 to 6 years retrospective comparative follow-up study.

Abstract

A central-splitting and complete detachment of the Achilles tendon are common surgical approaches in Haglund's disease surgery. The objective of this study was to compare the 2- to 6-year clinical and radiographic outcomes between central-splitting and complete Achilles tendon detachment. The study involved patients with Haglund's disease who underwent surgery at our institution from 2018 to 2023. Demographic data and preoperative visual analogue scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) for Activities of Daily Living (ADL) were collected. At the final follow-up, postoperative VAS for pain, FAAM for ADL, and plantar-flexion strength was evaluated. Postoperative imaging was analyzed using the parallel pitch line and the Chauveaux-Liet angle to evaluate the 'radiographic complete bone removal'. A total of 77 patients were recruited; 35 treated using central-splitting and 42 using the complete detachment approach. There was no statistically significant difference in demographic characteristics among the groups. The result demonstrated that FAAM for ADL was statistically significant higher in central splitting detachment as mean 87.4 (SD = 4.2) vs 82.4 (SD = 6.4), p < 0.0001. There was no statistically significant difference for the VAS for pain, plantar-flexion strength, radiographic complete bone removal and complications. Central-splitting detachment could provide a significantly better functional outcome compared to complete detachment of Achilles tendon for the Haglund's disease surgery during 2 to 6 years of follow-up.