Functional outcomes and return to sports after surgical treatment of insertional Achilles tendinopathy: Surgical approach tailored to the degree of tendon involvement - 11/06/18

Doi : 10.1016/j.otsr.2018.05.003

Alexandre Hardy ^a,^⁎ , Romain Rousseau ^a, Samir-Pierre Issa ^a, Antoine Gerometta ^a, Hugues Pascal-Moussellard ^a, Benjamin Granger ^b, Frédéric Khiami ^a
^a Service de chirurgie orthopédique et traumatologie du sport, CHU de La Pitié-Salpêtrière, 47–83, boulevard de l’Hôpital, 75013 Paris, France
^b Département de biostatistique et de santé publique, CHU de La Pitié-Salpêtrière, 47–83, boulevard de l’Hôpital, 75013 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

Insertional Achilles tendinopathy is a generic term that encompasses several types of ailments. While conservative treatment is less effective than for conditions isolated to the tendon body, there is no consensus as to the best type of surgical care.

Hypothesis

Surgical treatment for insertional Achilles tendinopathy that is tailored to the severity of the tendon involvement will lead to satisfactory functional outcomes.

Material and methods

Forty-six patients were included with an average age of 44.1±11.4 years and a mean preoperative AOFAS score of 62.2±11.7. The mean duration of symptoms before the surgery was 33.1±24 months. The inclusion criteria were pain at the tendon insertion and failure of at least 6 months of conservative treatment. Tendon involvement was evaluated preoperatively using MRI and confirmed intraoperatively after debridement. The primary treatment in all patients was resection of the calcaneal abnormality. Depending on the degree of tendon involvement, debridement or detachment/reattachment were also performed. The minimum follow-up was 12 months.

Results

The mean follow-up was 33±13.5 months. None of the patients were lost to follow-up. The mean AOFAS score was 93.7±7.3 at the last follow-up. The ATRS and VISA-A scores were 89.2±4.1 and 89±3.2, respectively. The sports participation level was the same or higher in 71.7% of cases. Increased preoperative passive dorsiflexion was statistically correlated with the degree of tendon involvement.

Conclusion

Surgery for insertional Achilles tendinopathy led to good functional outcomes and satisfactory return to sports when the surgical care was tailored to the sdegree of tendon involvement.