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Open vs Endoscopic Surgical Treatment for Haglund Deformity: A Systematic Review, Meta-analysis, and Meta-regression
Alex Guedes1,2, Enilton de Santana Ribeiro de Mattos1,2, Eduardo Silva Reis Barreto1,2
1Orthopedics and Traumatology Research Group, Federal University of Bahia (UFBA), Salvador, Bahia State, Brazil.
Insights
This review found no significant difference in ankle function or pain between open and endoscopic surgery for Haglund deformity. Open surgery was faster, but both methods had serious bias risks, necessitating further research.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Haglund deformity causes posterior heel pain and Achilles tendinopathy.
- Surgical resection is considered when conservative treatments fail.
- This study compares open and endoscopic surgical techniques for Haglund deformity.
Purpose of the Study:
- To compare clinical and functional outcomes of open versus endoscopic surgery for Haglund deformity.
- To evaluate postoperative ankle function, operative time, pain, and adverse events.
- To synthesize current evidence on surgical management of Haglund deformity.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Included randomized trials and observational cohort studies comparing open and endoscopic surgery.
- Analyzed postoperative ankle function (AOFAS, VISA-A), operative time, pain (VAS), and adverse events.
Main Results:
- Five cohort studies with 226 patients were included (127 endoscopic, 99 open).
- No significant difference in postoperative ankle function or pain between techniques.
- Open surgery demonstrated a shorter operative time, but all studies had a serious risk of bias.
Conclusions:
- Current evidence does not show clear superiority of open or endoscopic surgery for Haglund deformity.
- Limitations include study bias and outcome measurement properties.
- High-quality randomized trials with standardized outcomes are needed to guide surgical decisions.
Background:
Haglund deformity, characterized by a bony prominence at the posterosuperior aspect of the calcaneus, is a frequent cause of posterior heel pain and Achilles tendinopathy. When conservative treatment fails, surgical resection is indicated. This systematic review and meta-analysis aimed to compare clinical and functional outcomes of open and endoscopic surgery in adults with Haglund deformity.
Methods:
The review followed PRISMA guidelines, was registered in PROSPERO (CRD420251061639), and included randomized trials or observational cohort studies directly comparing both techniques. The primary outcome was postoperative ankle function (American Orthopaedic Foot & Ankle Society score or the Victorian Institute of Sports Assessment-Achilles questionnaire scores); secondary outcomes included operative time, postoperative pain (visual analog scale), and adverse events. Random effects (restricted maximum likelihood) meta-analyses were performed, and risk of bias was assessed using the ROBINS-I tool.
Results:
Five cohort studies, totaling 226 patients (127 endoscopic, 99 open), met the inclusion criteria. The meta-analysis showed no significant difference in postoperative ankle function between techniques (standardized mean difference = -0.19, 95% CI -0.72 to 0.35; I² = 66.7%). Operative time was shorter in the open surgery group (mean difference = -11.73 minutes, 95% CI -23.03 to -0.42; I² = 94.6%). No significant differences were observed in postoperative pain or adverse events. All studies had a serious overall risk of bias.
Conclusion:
The available comparative observational evidence does not demonstrate clear superiority of either technique for the evaluated outcomes. Interpretation of symptom and function outcomes is limited by the measurement properties of the instruments used in the source studies. These findings represent a conservative synthesis of the best comparative evidence currently available and highlight the need for adequately powered randomized clinical trials with standardized outcome measures to more reliably inform surgical decision making.
