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Transtendinous approach calcaneoplasty versus endoscopic calcaneoplasty for Haglund’s disease

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Abstract

Purpose

In this study, we performed a comparison between open calcaneoplasty through transtendinous approach and endoscopic calcaneoplasty for Haglund’s disease.

Methods

A retrospective review was performed of patients who had undergone either a calcaneoplasty with transtendinous approach or endoscopic for Haglund’s disease from three centres. Inclusion criteria were patients with Haglund’s disease confirmed radiographically, neutral alignment of the hindfoot and at least one year of follow-up. Patients were excluded in case of ipsilateral ankle osteoarthritis or other neighbouring joints, previous foot surgery, hindfoot malalignment and marked calcific insertional Achilles tendinosis. A chart review was performed to collect demographic data, including age, sex and body mass index (BMI). Functional outcome analysis included the Foot Function Index, AOFAS score and VAS for pain pre-operatively and post-operatively at the last follow-up. This patient-reported outcome scores were used in the native language of each patient (Italian).

Results

Clinical and functional outcomes were collected from 54 patients (28 heels treated by open technique and 26 heels treated by endoscopic technique). In the open group, the AOFAS score improved from a pre-operative value of 65.67 ± 10.09 points to a value of 91.78 ± 9.67 points at the last follow-up (P < 0.05). In the endoscopic group, the AOFAS score improved from a pre-operative value of 66.69 ± 7.19 points to a value of 93.69 points ± 10.04 at the last follow-up (P < 0.05). The VAS and the FFI (Disability and Pain) scores were also improved significantly in both groups at the final follow-up evaluation (P < 0.001). Comparing the final follow-up post-operative clinical scores between the two groups, there was no difference in the AOFAS, VAS or the FFI scores between the two groups. No major complications were recorded, except for one Achilles tendon tear after open calcaneoplasty. The satisfaction rate was similar for both techniques.

Conclusions

Both techniques provided good clinical outcomes with a low rate of complications.

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References

  1. Haglund P (1997) Beitrag zur klinik der Achilles tendon. Z Orthop Chir 49:49

    Google Scholar 

  2. Georgiannos D, Kitridis D, Bisbinas I (2018) Dorsal closing wedge calcaneal osteotomy for the treatment of insertional Achilles tendinopathy: a technical tip to optimize its results and reduce complications. Foot Ankle Surg 24:115–118

    Article  CAS  PubMed  Google Scholar 

  3. Labib SA, Pendleton AM (2012) Endoscopic calcaneoplasty: an improved technique. J Surg Orthop Adv 21:176–180

    Article  PubMed  Google Scholar 

  4. Vaishya R, Agarwal AK, Azizi AT, Vijay V (2016) Haglund’s syndrome: a commonly seen mysterious condition. Cureus 8:e820

    PubMed  PubMed Central  Google Scholar 

  5. Tu P (2018) Heel pain: diagnosis and management. Am Fam Physician 97:86–93

    PubMed  Google Scholar 

  6. Reinherz RP, Smith BA, Henning KE (1990) Understanding the pathologic Haglund’s deformity. J Foot Surg 29:432–435

    CAS  PubMed  Google Scholar 

  7. Kang S, Thordarson DB, Charlton TP (2012) Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int 33:487–491

    Article  PubMed  Google Scholar 

  8. Maffulli N, Via AG, Oliva F (2015) Chronic Achilles tendon disorders: tendinopathy and chronic rupture. Clin Sports Med 34:607–624

    Article  PubMed  Google Scholar 

  9. Hardy A, Rousseau R, Issa SP, Gerometta A, Pascal-Moussellard H, Granger B, Khiami F (2018) Functional outcomes and return to sports after surgical treatment of insertional Achilles tendinopathy: surgical approach tailored to the degree of tendon involvement. Orthop Traumatol Surg Res 104:719–723

    Article  PubMed  Google Scholar 

  10. Lohrer H, Arentz S (2003) Distal anterior Achilles tendon impingement lesion corresponding to retrocalcaneal bursitis and Haglund’s syndrome. Sportverletz Sportschaden 17:181–188

    Article  CAS  PubMed  Google Scholar 

  11. Sammarco GJ, Taylor L (1998) Operative management of Haglund’s deformity in the nonathlete: a retrospective study. Foot Ankle Int 19:724–729

    Article  CAS  PubMed  Google Scholar 

  12. Schneider W, Niehus W, Knahr K (2000) Haglund’s syndrome: disappointing results following surgery - a clinical and radiographic analysis. Foot Ankle Int 21:26–30

    Article  CAS  PubMed  Google Scholar 

  13. Baumbach SF, Braunstein M, Mack MG, Maßen F, Böcker W, Polzer S, Polzer H (2017) Insertional Achilles tendinopathy: differentiated diagnostics and therapy. Unfallchirurg 120:1044–1053

    Article  CAS  PubMed  Google Scholar 

  14. Ohtori S, Inoue G, Mannoji C, Saisu T, Takahashi K, Mitsuhashi S, Wada Y, Takahashi K, Yamagata M, Moriya H (2001) Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neurosci Lett 315:57–60

    Article  CAS  PubMed  Google Scholar 

  15. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC (2003) Shock wave therapy induces neovascularization at the tendon–bone junction. A study in rabbits. J Orthop Res 21:984–989

    Article  PubMed  Google Scholar 

  16. Jerosch J, Nasef NM (2003) Endoscopic calcaneoplasty - rationale, surgical technique, and early results: a preliminary report. Knee Surg Sports Traumatol Arthrosc 11:190–195

    Article  CAS  PubMed  Google Scholar 

  17. Ettinger S, Razzaq R, Waizy H, Claassen L, Daniilidis K, Stukenborg-Colsman C, Plaass C (2016) Operative treatment of the insertional Achilles tendinopathy through a transtendinous approach. Foot Ankle Int 37:288–293

    Article  PubMed  Google Scholar 

  18. Xu JH, Ding SL, Chen B, Wu SC (2018) Modified Bunnell suture expands the surgical indication of the treatment of Haglund’s syndrome heel pain with endoscope. Exp Ther Med 15:4817–4821

    PubMed  PubMed Central  Google Scholar 

  19. Vernois J, Redfern D, Ferraz L, Laborde J (2015) Minimally invasive surgery osteotomy of the hindfoot. Clin Podiatr Med Surg 32:419–434

    Article  PubMed  Google Scholar 

  20. Caudell GM (2017) Insertional Achilles tendinopathy. Clin Podiatr Med Surg 34:195–205

    Article  PubMed  Google Scholar 

  21. Sergio F, Catani O, Fusini F, Langella F, Cautiero G, Ponzo I, Zanchini F (2018) Treating Haglund’s deformity with percutaneous Achilles tendon decompression: a case series. Muscles Ligaments Tendons J 8:488–494

    Article  Google Scholar 

  22. Van Dijk CN, Dyk E, Scholten PE, Kort NP (2001) Endoscopic calcaneoplasty. Am J Sports Med 29:185–189

    Article  PubMed  Google Scholar 

  23. Watson AD, Anderson RB, Davis WH (2000) Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional Achilles tendinosis with calcific spur. Foot Ankle Int 21:638–642

    Article  CAS  PubMed  Google Scholar 

  24. Van Dijk CN, Scholten PE, Krips R (2000) A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 16:871–876

    Article  PubMed  Google Scholar 

  25. Leitze Z, Sella EJ, Aversa JM (2003) Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am 85A:1488–1496

    Article  Google Scholar 

  26. Ortmann FW, McBryde AM (2007) Endoscopic bony and soft tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int 28:149–153

    Article  PubMed  Google Scholar 

  27. Martinelli N, Scotto GM, Sartorelli E, Bonifacini C, Bianchi A, Malerba F (2014) Reliability, validity and responsiveness of the Italian version of the Foot Function Index in patients with foot and ankle diseases. Qual Life Res 23:277–284

    Article  PubMed  Google Scholar 

  28. Leigheb M, Janicka P, Andorno S, Marcuzzi A, Magnani C, Grassi F (2016) Italian translation, cultural adaptation and validation of the “American Orthopaedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale”. Acta Biomed 87:38–45

    PubMed  Google Scholar 

  29. Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M (2018) Endoscopic Achilles tendon augmentation with suture anchors after calcaneal exostectomy in Haglund syndrome. Foot Ankle Int 39:551–559

    Article  PubMed  Google Scholar 

  30. Phisitkul P (2012) Endoscopic surgery of the Achilles tendon. Curr Rev Musculoskelet Med 5:156–163

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lughi M (2020) Haglund’s syndrome: endoscopic or open treatment? Acta Biomed 91:167–171

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Jerosch J, Sokkar S, Ducker M, Donner A (2012) Endoscopic calcaneoplasty (ECP) in Haglund’s syndrome. Indication, surgical technique, surgical findings and results. Z Orthop Unfall 150:250–256

    Article  CAS  PubMed  Google Scholar 

  33. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P (2017) Current concepts review update: insertional Achilles tendinopathy. Foot Ankle Int 38:1160–1169

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kaynak G, Ogut T, Yontar NS, Botanlioglu H, Can A, Unlu MC (2013) Endoscopic calcaneoplasty: five-year results. Acta Orthop Traumatol Turc 47:261–265

    Article  PubMed  Google Scholar 

  35. Appala Raju S, Rajasekhara Rao G, Vijayabhushanam M, Venkateswara Rao M, Anil B (2015) Comparison of open versus endoscopic calcaneoplasty for Haglund’s deformity: a short term analysis. J Evolut Med Dental Sci 4:1930–1934

    Google Scholar 

  36. Wiegerinck JI, Kok AC, Van Dijk CN (2012) Surgical treatment of chronic retrocalcaneal bursitis. Arthroscopy 28:283–293

    Article  PubMed  Google Scholar 

  37. Javali V, Reddy VN (2017) Haglund’s disease: surgical outcome of calcaneal osteotomy. Int J Res Orthop 3:278–281

    Article  Google Scholar 

  38. Jerosch J, Schunck J, Sokkar SH (2007) Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc 15:927–934

    Article  PubMed  Google Scholar 

  39. Lin C, Ma L, Chen W, Tao X, Yuan CS, Zhou BH, Tang KL (2017) A comparative study of the calcaneal closing-wedge calcaneal osteotomy versus posterior-superior prominence removal in both sides with Haglund syndrome. Zhonghua Yi Xue Za Zhi 97:2733–2736

    CAS  PubMed  Google Scholar 

  40. Schepsis AA, Wagner C, Leach RE (1994) Surgical management of Achilles tendon overuse injuries: a long-term follow-up study. Am J Sports Med 22:611–619

    Article  CAS  PubMed  Google Scholar 

  41. Roth KE, Mueller R, Schwand E, Maier GS, Schmidtmann I, Sariyar M, Maus U (2014) Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans. J Foot Ankle Res 7:56

    Article  PubMed  PubMed Central  Google Scholar 

  42. Scholten PE, Van Dijk CN (2006) Endoscopic calcaneoplasty. Foot Ankle Clin 11:439–446

    Article  PubMed  Google Scholar 

  43. Syed TA, Perera A (2016) A proposed staging classification for minimally invasive management of Haglund’s syndrome with percutaneous and endoscopic surgery. Foot Ankle Clin 21:641–664

    Article  PubMed  Google Scholar 

  44. Lohrer H, Nauck T, Dorn NV, Konerding MA (2006) Comparison of endoscopic and open resection for Haglund tuberosity in a cadaver study. Foot Ankle Int 27:445–450

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy

    Andrea Cusumano, Nicolò Martinelli, Alberto Bianchi & Valerio Sansone

  2. Clinica Eporediese, Ivrea, Italy

    Angelo Bertelli

  3. Clinica San Francesco, Verona, Italy

    Alberto Marangon

  4. Department of Orthopedics, University of Milan, Milan, Italy

    Valerio Sansone

Authors
  1. Andrea Cusumano
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  2. Nicolò Martinelli
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  3. Alberto Bianchi
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  4. Angelo Bertelli
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  5. Alberto Marangon
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  6. Valerio Sansone
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Corresponding author

Correspondence to Nicolò Martinelli.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cusumano, A., Martinelli, N., Bianchi, A. et al. Transtendinous approach calcaneoplasty versus endoscopic calcaneoplasty for Haglund’s disease. International Orthopaedics (SICOT) 45, 225–231 (2021). https://doi.org/10.1007/s00264-020-04761-0

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  • DOI: https://doi.org/10.1007/s00264-020-04761-0

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