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Landmarks for a Minimally Invasive Approach for Haglund's Deformity: A Cadaveric Study
Sara Mateen1, James Cottom2, Asma Jappar3
1International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Insights
This cadaveric study identifies safe landmarks for a minimally invasive surgical (MIS) approach to Haglund's deformity. The described portals allow for Haglund's deformity resection without neurovascular compromise.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Minimally Invasive Procedures
Background:
- Haglund's deformity involves a calcaneal prominence linked to bursitis and Achilles tendinopathy.
- Previous endoscopic debridement techniques exist.
- This study focuses on anatomical landmarks for a minimally invasive surgical (MIS) approach.
Purpose of the Study:
- To describe the anatomical landmarks for a minimally invasive surgical (MIS) approach to Haglund's deformity.
- To evaluate the safety of MIS portals in relation to neurovascular structures.
Main Methods:
- Cadaveric dissection of 12 specimens.
- Identification of medial and lateral portals for burr and anchor placement.
- Measurement of distances from neurovascular structures to portals and incisions.
Main Results:
- Average distance from the sural nerve to the lateral portal: 25.7 mm.
- Mean distance from the tibial nerve to the medial portal: 35.3 mm.
- Incisions were 9.3 mm from the calcaneal tuberosity.
Conclusions:
- The MIS approach for Haglund's deformity resection is feasible.
- The technique can be performed reliably without compromising neurovascular structures.
Introduction:
Haglund's deformity is a posterosuperior calcaneal prominence often associated with a painful bursa and insertional Achilles tendinopathy. Endoscopic debridement has been previously described; however, the aim of this cadaveric study is to describe landmarks of a minimally invasive surgical (MIS) approach to Haglund's deformity.
Methods:
Twelve specimens were dissected to identify medial and lateral portals for minimally invasive burr placement and anchor placement. A standard ruler was used to measure the distance in millimeters from the medial and lateral neurovascular structures in relation to medial and lateral portals. A separate 7-cm longitudinal incision posterior to the lateral malleolus and a separate 7-cm longitudinal incision posterior to the medial malleolus were made to identify at-risk neurovascular structures.
Results:
The average distance from the sural nerve to the lateral portal was 25.7 mm (23-26). The mean distance from the lateral calcaneal branch of the sural nerve to lateral portal was 11.4 mm (10-12). The mean distance from the tibial nerve to the medial portal was 35.3 mm (35-36). Both the medial and lateral incisions were 9.3 mm from the calcaneal tuberosity.
Conclusion:
The results indicate that the MIS approach to Haglund's deformity resection can be performed reliably without neurovascular compromise.
Levels Of Evidence:
Level IV.
