ハギルンド変形に対するトップアーズマイクロテンノトミーを併用した内視鏡的踵骨形成術：比較研究

Haglund's deformity is a common cause of posterior heel pain which can be treated by endoscopic calcaneoplasty. Adjunctive biologic modalities such as Topaz radiofrequency microtenotomy have been proposed to target intrinsic tendon pathology. This study aims to evaluate the functional outcomes of endoscopic calcaneoplasty for Haglund's deformity, with or without adjunctive Topaz. We hypothesised that adding Topaz will improve outcomes by addressing the concomitant pathologies of the Haglund's triad.

This retrospective superiority study was conducted between July 2020 and October 2024 in Singapore. Patients with Haglund's deformity were randomly assigned to undergo endoscopic calcaneoplasty with or without adjunctive Topaz. Outcomes were measured using Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Foot Function Index (FFI) score pre-operatively and post-operatively at their final follow-up.

63 cases (64 feet in 56 patients) were included. 44 cases underwent endoscopic calcaneoplasty only while 19 cases received additional Topaz therapy. In the calcaneoplasty-only group: VAS improved from 7.7 ± 1.8-0.7 ± 1.5, AOFAS from 57.3 ± 13.9-94.4 ± 9.1, and FFI from 55.5 ± 23.5-7.7 ± 14.8. In the combined group: VAS improved from 8.4 ± 1.2-1.4 ± 2.0, AOFAS from 54.2 ± 12.3-92.3 ± 10.6, FFI from 55.3 ± 23.4-12.2 ± 19.1. No significant differences were observed between the groups pre-operatively and post-operatively at their final follow-up (mean duration 33.7 months).

Endoscopic calcaneoplasty effectively relieves pain and restores function in Haglund's deformity. However, the addition of adjunctive Topaz did not confer any additional benefits in the long term at a mean follow-up duration of 33.7 months.