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[Endoscopic calcaneoplasty (ECP) in Haglund's syndrome. Indication, surgical technique, surgical findings and
J Jerosch1, S Sokkar, M Dücker
1Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Johanna-Etienne-Krankenhaus, Neuss. j.jerosch@ak-neuss.de
Insights
Endoscopic calcaneoplasty (ECP) offers an effective, minimally invasive treatment for posterior calcaneal exostosis. This technique shows superior outcomes and fewer complications compared to open surgery, making it a valuable option for patients with Achilles tendon issues.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Foot and Ankle Surgery
Background:
- Posterior calcaneal exostosis (PCE) treatment is controversial, with open surgery often yielding unsatisfactory results and complications.
- Conservative treatment failure necessitates surgical intervention for PCE.
- Endoscopic calcaneoplasty (ECP) presents a minimally invasive alternative to traditional open surgery.
Purpose of the Study:
- To evaluate the efficacy and outcomes of endoscopic calcaneoplasty (ECP) for treating posterior calcaneal exostosis.
- To compare ECP with traditional open surgical techniques regarding results and complications.
Main Methods:
- A retrospective study of 164 patients (16-67 years) with posterior superior calcaneal exostosis treated with ECP between 1999 and 2010.
- All patients had failed at least 6 months of conservative treatment and had no hind foot varus or cavus deformities.
- Average follow-up was 46.3 months; outcomes were assessed using the Ogilvie-Harris score.
Main Results:
- Excellent or good results were achieved in 165 out of 169 patients (97.6%).
- Postoperative radiographs confirmed sufficient spur resection; minor complications were observed.
- Preoperative MRI revealed partial Achilles tendon rupture in 61 patients, with no complete tears noted at follow-up.
Conclusions:
- Endoscopic calcaneoplasty (ECP) is an effective and minimally invasive treatment for calcaneal exostosis.
- ECP demonstrates superiority over open techniques with reduced morbidity, shorter operating times, and minimal complications.
- The endoscopic approach allows for better differentiation of pathology and improved patient outcomes.
Introduction:
Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems.
Material And Method:
Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months.
Results:
According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia.
Conclusion:
ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the pathology can be better differentiated.
