Intermediate and long-term outcomes of the suture bridge technique for the management of insertional achilles tendinopathy.
BACKGROUND
Insertional Achilles tendinopathy is a problem frequently encountered by the foot and ankle surgeon. Conservative care yields mixed results, and this condition is often treated surgically. Our hypothesis is that the suture bridge technique through a central posterior incision allows adequate visualization for thorough debridement and exostectomy and provides a stable tendon-to-bone interface for healing.


METHODS
The medical records of 35 patients who underwent surgical treatment for insertional Achilles tendinopathy with the suture bridge technique, by a single surgeon, between 2006 and 2012 were retrospectively reviewed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instruments as well as a subjective questionnaire were utilized.


RESULTS
In all, 30 individuals who met the inclusion criteria for the treatment of insertional Achilles tendinopathy were evaluated at a mean follow-up of 28.93 ± 16.99 months. We included 10 men and 20 women, with a mean age of 49.1 ± 9.2 years. The mean preoperative AOFAS score was 56.6 ± 14.0. The average postoperative AOFAS score significantly increased to 91.7 ± 10.4 (P < .0001). One participant required revisional surgery, consisting of a flexor hallucis longus transfer performed by another physician. There were no wound complications or infections. Overall, there was a 97% (28/29) satisfaction rate.


CONCLUSIONS
The central incision with complete detachment of the Achilles tendon and reattachment with the suture bridge technique for the treatment of insertional Achilles tendinopathy provides an effective treatment with good to excellent clinical outcomes in 97% of patients, with a mean follow-up of 29 months.
Foot and Ankle Center of Nebraska, Omaha, NE, USA.
Robert M
RM
Greenhagen
Andrew B
AB
Shinabarger
Kyle T
KT
Pearson
Patrick R
PR
Burns
D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D052256:Tendinopathy / Q000601:surgery*; D016896:Treatment Outcome
Achilles tendonitis; ankle; bone (heel, toe) spurs; complex foot and ankle conditions; diagnostic and therapeutic techniques; foot surgery techniques; general disorders; heel; rearfoot; reconstructive foot and ankle surgery