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Recovery After Surgery for Insertional Achilles Tendinopathy With and Without Bioinductive Scaffold Augmentation: A
Gil Genuth1, Peter Stavrou2, Lukas D Iselin3
1Assuta Medical Centre, Tel Aviv, Israel.
Background:
Insertional Achilles tendinopathy (IAT), often associated with Haglund deformity, is a common cause of posterior heel pain, with up to 40% of patients requiring surgical intervention after unsuccessful conservative treatment. Bioinductive collagen scaffolds have been proposed as a potential adjunct for tendon healing.
Purpose:
To evaluate clinical and structural outcomes after open IAT surgery with and without scaffold augmentation.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A retrospective comparative cohort study was conducted between 2021 and 2024, including 30 consecutive patients (30 ankles) who underwent open IAT surgery with Haglund resection and double-row tendon reattachment performed by a single surgeon. Fifteen patients underwent standard repair, and 15 received additional augmentation with a bioinductive collagen scaffold. Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores were collected preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging (MRI) was obtained at study enrolment (baseline) and repeated at 12 months after surgery. Secondary outcomes included time to return to sport (RTS), and all postoperative complications were recorded. Minimal clinically important difference thresholds of 5 to 8 points for PF and 8 to 10 points for PI were applied. Statistical analysis included between-group comparisons at each time point and evaluation of changes over time, with significance set at P < .05.
Results:
Preoperative PROMIS scores were similar between groups (PF: 39.8 ± 5.7 vs 40.4 ± 6.1; PI: 64.1 ± 6.4 vs 63.7 ± 5.9). At 6 months, both groups improved, with greater change in the scaffold group (PF: 54 ± 5.3 vs 49.5 ± 6; P = .03; PI: 50.6 ± 6.1 vs 55.3 ± 6.4; P = .04). At 12 months, PROMIS scores were similar (PF: 58.1 ± 4.9 vs 57 ± 5.1; P = 0.41; PI: 47.2 ± 5.4 vs 48.5 ± 5; P = 0.38), and this was maintained at 18 months (PF: 59.4 ± 4.7 vs 58.7 ± 4.9; P = 0.67; PI: 45.9 ± 5.1 vs 46.7 ± 4.8; P = .59). Time to RTS was shorter in the scaffold group (8 ± 1.7 vs 9.7 ± 2.1 months; P = .02). MRI at 12 months showed tendon integrity in all cases, and complication rates were low and comparable between groups.
Conclusion:
Our study shows that bioinductive scaffold augmentation in open IAT surgery is safe and may be associated with earlier improvements in pain, function, and RTS, while longer-term outcomes are similar to standard repair. These findings suggest a potential role for this approach in active individuals seeking a faster recovery.
