Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

BACKGROUND: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. METHODS: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. RESULTS: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively (P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively (P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up (P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). CONCLUSION: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. LEVEL OF EVIDENCE: Level IV, retrospective case series.