title: Calcific insertional Achilles tendinopathy: reattachment with bone anchors.
abstract: BACKGROUND
  Recalcitrant calcific insertional Achilles tendinopathy is difficult to treat.
  
  
  OBJECTIVE
  Bursectomy, excision of the distal paratenon, disinsertion of the tendon, removal of the calcific deposit, and reinsertion of the Achilles tendon with bone anchors is safe and effective.
  
  
  METHODS
  Longitudinal study.
  
  
  METHODS
  Twenty-one patients (six women) (21 feet) (average age 46.9 +/- 6.4 years) with recalcitrant calcific insertional Achilles tendinopathy were treated surgically with removal of the calcific deposit; the Achilles tendon was reinserted with bone anchors.
  
  
  RESULTS
  At an average follow-up of 48.4 months, one patient necessitated a further operation. Eleven patients reported an excellent result, and five a good result. The remaining five patients could not return to their normal levels of sporting activity and kept fit by alternative means. The results of the VISA-A questionnaire were markedly improved in all patients, from an average of 62.4% to 88.1%.
  
  
  CONCLUSIONS
  We recommend disinsertion of the Achilles tendon to excise the calcific deposit fully and reinsertion of the Achilles tendon in the calcaneus with suture anchors. No patient experienced a traumatic disinsertion of the reattached tendon. However, five patients were not able to return to their original level of physical activity.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Staffordshire, England.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Vittorino
authors.initials: V
authors.lastname: Testa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capasso
authors.forename: Alessio
authors.initials: A
authors.lastname: Sullo
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*