Percutaneous Debridement and Double-Row Repair for Insertional Achilles Tendinopathy With Immediate Postoperative Weightbearing: A Consecutive Case Series.

Abstract

Background: Percutaneous treatment of insertional Achilles tendinopathy is gaining popularity. The objectives of this study were to show that a percutaneous double-row repair technique with immediate postoperative weightbearing (1) allows safe access to both the Haglund deformity and the Achilles enthesophyte with radiographic resolution of pathology and (2) was associated with clinical outcomes with no early weightbearing-related complications.

Methods: A retrospective cohort study was conducted of consecutive patients. Correction was accomplished with an MIS burr and double-row repair technique through percutaneous incisions with fluoroscopic assistance. Patients were allowed to immediately weight-bear in a pneumatic walking boot with four 5° wedges (totaling 20° wedge) with progressive near-weekly wedge removal until return to normal shoes at 5.5 weeks. Patient demographic data and intraoperative data were recorded, as were pre- and postoperative patient-reported outcomes, radiographic measures, and short-term complications.

Results: Sixty-one consecutive patients were included with a mean follow-up of 12.1 ± 5.7 months (range, 1.5-24 months). Preoperative mean spur length and width improved from 14.29 (SD 7.38) mm and 5.88 (SD 2.49) mm to 0 mm postoperatively in all patients (P < .05). Spur-to-skin distance improved from 7.38 (SD 2.00) mm to 14.76 (SD 3.57) mm (P < .05). Mean FADI increased from 56.30 (95% CI, 52.9-59.7) to 96.82 (95% CI, 95.3-98.3) (P < .05) at the 12-month follow-up, and mean VAS decreased from 7.25 (95% CI, 7.01-7.49) preoperatively to 0.47 (95% CI, 0.17-0.77) at 12 months. No patients required repeat surgery, and there were no postoperative Achilles tendon ruptures. Eleven patients reported minor complications within 3 months of surgery.

Conclusion: The findings of this study suggest that percutaneous insertional Achilles debridement and repair using a double-row repair technique with immediate weightbearing was associated with improvement in radiographic parameters and patient-reported outcomes through 12 months, with no postoperative tendon ruptures, no revision surgery, and a low overall complication rate.

Level of evidence: Level IV, retrospective case series.