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Excisional Debridement for Chronic Achilles Insertional Tendinosis: A Novel Technique and Case Review
Tara E Gaston1,2, Hope E Skibicki1,2, Quincy T Cheesman1,2
1Rowan University School of Osteopathic Medicine, Stratford, New Jersey (TEG, HES, QTC); NYU Winthrop Hospital, Garden City, New York (MCC).
Background:
Operative treatment of chronic Achilles insertional tendinosis (AIT) involves tendon debridement, removal of the retrocalcaneal bursitis, and excision of the calcaneal exostosis, often followed by repair of the Achilles tendon and deep tendon transfer. The literature describes a variety of techniques without a single standard of care.
Methods:
This is a retrospective review of 57 patients treated with an excisional debridement of the central portion of the Achilles tendon. The novelty of this technique is that instead of complete detachment of the tendon from its insertion, only the central portion is debrided and excised. This allows for enhanced visibility of the calcaneal exostosis and increased healing with apposition of viable tendon during side-to-side repair.
Results:
Patient-reported outcome scores and pain significantly improved from preoperatively to a minimum of 2 years postoperatively. Complications were similar to those previously reported, with superficial wound breakdown being the most common.
Conclusion:
In conclusion, the use of this reliable, reproducible, and effective technique for the treatment of patients with chronic AIT is encouraged because it provides both enhanced visibility and allows complete resection of all pathological tissue.
Levels Of Evidence:
Level IV: Retrospective case series.
