Results of Reinsertion of the Distal Achilles Tendon

Reattachment of the distal Achilles tendon to the posterior calcaneus following distal Achilles tendon tears/avulsions or after excision of large posterior heel spurs is a challenging task for the orthopaedic surgeon.

Between 2005 and the end of 2015, 22 patients who underwent repair/reconstruction of a lesion of the distal Achilles tendon were identified from our electronic records. Calcaneal reinsertions were performed following distal Achilles tendon tears/avulsions (n = 15) or following excision of a large symptomatic posterior heel spur (n = 7). The respective outcome was evaluated comparatively using the VISA-A - G (Victorian Institute of Sports Assessment-Achilles tendon, German version) questionnaire (100 = maximum). Data were collected preoperatively (n = 11/22), and prospectively at three, six, and 12 months postoperatively (n = 5 - 11/22). Two further retrospective follow-ups were performed 12 - 114 and 21 - 149 months postoperatively (n = 17/22 and 22/22, respectively). All data were analysed retrospectively. Complications were searched from the electronic files.

Transosseous sutures and different anchor techniques (Panalok^®, Corkscrew^®, SpeedBridge^®) were generally performed. Preoperatively, the VISA-A - G score was 27.3 ± 13.5 (6 - 45) following distal Achilles tendon reinsertions for avulsions and 45.3 ± 49.0 (0 - 100) when reattachment was performed after resection of a large posterior heel spur (p = 0.831). At the final follow-up, VISA-A - G values were 89.4 ± 13.9 (54 - 100) following distal Achilles tendon tear/avulsion and 82.5 ± 24.5 (51 - 100), when Achilles tendons were reattached after posterior heel spur excisions (p = 0.969). There were no complications in the "heel spur group". In the Achilles tendon tear/avulsion group, four out of seven patients with Panalok^® repairs developed a fistula. One patient suffered a thromboembolism. None of these complications affected the long-term outcome.

This study demonstrates good long-term outcomes after distal Achilles tendon reinsertion. Knotless double row anchor repair provides a greater area of compression, simplifies and standardises the repair/reconstruction, and provides safety against fistula. These implants are therefore recommended for safe and effective reattachment of the distal Achilles tendon.