title: Operative Treatment of the Insertional Achilles Tendinopathy Through a Transtendinous Approach.
abstract: BACKGROUND
  Different operative techniques have been proposed for the treatment of insertional Achilles tendinopathy (IAT), with often disappointing results. The aim of this study was to evaluate the outcome of the transtendinous approach in IAT.
  
  
  METHODS
  Forty patients operated with an IAT between 2010 and 2011 were included in this retrospective study. The mean follow-up was 15.6 (±3.7, 12-27) months. Indication for surgery was IAT with failed conservative therapy. Using a transtendinous approach, the Achilles tendon (AT) was partially detached and all pathologic tissues were debrided. The AT was reinserted using different anchor techniques. Clinical data were recorded using examination and clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS], Foot and Ankle Outcome Score [FAOS], Numerical Rating Scale [NRS], and Short Form-36 [SF-36]).
  
  
  RESULTS
  The mean AOFAS hindfoot score improved from 59.4 preoperatively to 86.5 postoperatively (P < .05). All FAOS subscales, NRS pain scores, and pain and function subscales of SF-36 improved significantly. The median time of return to work and sports was 14.5 (±17.6; 2-82) and 22.7 (±13.4; 7-58) weeks. Three patients had superficial wound healing difficulties but required no revision. One patient had to be revised due to a hematoma. Patients treated with 2 suture anchors or double-row fixation technique improved significantly (P < .05) compared to those with single anchor fixation, regarding AOFAS score (79.6 and 90.2) and FAOS subscale scores. Eighty-three percent of the patients showed good to excellent results.
  
  
  CONCLUSIONS
  The transtendinous approach allowed access to all associated pathologies in IAT. It had relatively few complications and lead to good clinical results.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Germany sarah@ettinger.info.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ettinger
authors.affiliation: Department of Trauma Surgery, Helios Clinic, Hildesheim, Germany.
authors.forename: Rameez
authors.initials: R
authors.lastname: Razzaq
authors.affiliation: Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany.
authors.forename: Hazibullah
authors.initials: H
authors.lastname: Waizy
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Germany.
authors.forename: Leif
authors.initials: L
authors.lastname: Claassen
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Germany.
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Daniilidis
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Stukenborg-Colsman
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Plaass
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D012189:Retrospective Studies; D000068958:Return to Sport; D062707:Return to Work; D053441:Suture Anchors; D052256:Tendinopathy / Q000601:surgery*; D055815:Young Adult
keywords: Achilles tendon; Haglund exostosis; insertional tendinopathy; transtendon approach