Comparison of open and endoscopic techniques of isolated calcaneoplasty in the surgical treatment of insertional tendinopathy of the Achilles tendon - 28/09/24

Doi : 10.1016/j.otsr.2024.104003

Alexis Thiounn ^a,⁎ , Guillaume Cordier ^b, Yves Tourne ^c, Thomas Bauer ^d, Olivier Boniface ^e, Nicolas Cellier ^f, Frederic Leiber ^g, Ronny Lopes ^h, François Molinier ⁱ, Giovanni Padiolleau ^j, Alexandre Hardy ^k, David Ancellin ^l, Michael Andrieu ^m, the Francophone Arthroscopy Society (SFA) ⁿ
^a Institut Main Pied Plastique Articulation Chirurgie Traumatologie (IMPPACT), Clinique Lille Sud, 96 rue Gustave Delory, 59810 Lesquin, France
^b Clinique du Sport, Vivalto Santé, Bordeaux-Merignac, - MIFAS by GRECMIP (Min- Imally Invasive Foot and Ankle Society), 2 rue Negrevergne, Merignac, 33700, France
^c Clinique des Cèdres, 5 rue des Tropiques, 38130 Echirolles, France
^d Hôpital Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
^e Clinique Générale, 4 Chemin De la Tour la Reine, 74000 Annecy, France
^f Centre Hospitalier Nîmes, 285 Rue Gilles Roberval, 30900 Nîmes, France
^g Cabinet de Chirurgie Orthopédique de l'Orangerie - Pôle pied/cheville, 12 Allée de la Robertsau, 67000 Strasbourg, France
^h Centre Orthopédique SANTY Gerland - Unité Cheville Pied, 359 Av. Jean Jaurès, 69007 Lyon, France
ⁱ Medipole Garonne, 45 Rue de Gironis, 31036 Toulouse, France
^j Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France
^k Clinique du Sport, 55 Rue Cortambert, 75116 Paris, France
^l Hopital Purpan, CHU Toulouse, Place du Docteur-Baylac, 31059 Toulouse, France
^m Clinique du Pont de Chaume, 330 avenue Marcel Unal, 82000 Montauban, France
ⁿ 15 rue Ampère, 92500 Rueil-Malmaison, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 28 September 2024

Abstract

Introduction

Insertional Achilles tendinopathy (IAT) is primarily caused by mechanical overload. Running and obesity are major risk factors. Medical treatment is limited, and surgery, particularly calcaneoplasty, is sometimes necessary. However, the choice between an endoscopic and open approach remains controversial.

Hypothesis

This study is based on the hypothesis that endoscopic surgery would allow for better functional recovery with a faster return to sports activity compared to traditional open techniques.

Materials and methods

Our multicenter prospective study compared the outcomes of endoscopic (Endo) and open (Open) calcaneoplasty in patients with IAT resistant to medical treatment. Clinical outcomes were assessed using the EFAS (daily life and sports) and VISA-AF scores. The radiological criteria studied were the calcaneal slope and the X/Y ratio. An MRI was used to quantify tendon involvement.

Results

Of the 85 patients included, 51 underwent endoscopic surgery, and 34 had open surgery. The two groups were comparable in terms of demographic, clinical, and radiographic characteristics. At 3 months postoperatively, significantly more patients had returned to sports in the Endo group (41.6% vs. 20.6% in the Open group; p = 0.004), and the EFAS sports score showed a significant difference in favor of the Endo group at 6 months postoperatively (9.3 vs. 5.7/16; p = 0.008).

Discussion

The results confirm faster recovery after endoscopic surgery, with comparable complication rates between the two approaches. However, long-term, the differences between the two techniques diminish, with similar functional outcomes at 12 months postoperatively.

Conclusion

Endoscopic calcaneoplasty is a safe and effective option for the treatment of IAT. However, further studies with longer follow-up are needed to confirm these results and assess recurrence rates.