Endoscopic treatment of Achilles tendon enthesopathies: An anatomical and clinical feasibility study

BACKGROUND: One possible treatment for Achilles tendon enthesopathy is open reconstruction of the Achilles tendon insertion by resection of calcified enthesis and the calcaneal tuberosity followed by reinsertion of the tendon with anchors. Subcutaneous dissection of the tendon in open procedure is at risk of wound complications. We hypothesized that this procedure could be performed under endoscopy. METHODS: An innovative operating technique was described. It consisted in removal and reinsertion of the Achilles tendon under endoscopy using five portals with resection of the calcaneal tuberosity and calcified enthesis. A feasibility study was first conducted on five cadaveric feet followed by an in vivo study on five patients. RESULTS: In all cases, the Achilles tendon could be reinserted with the same technique than in open surgery. None of the ten surgical procedures technically failed. It was possible to correctly resect calcifications and the calcaneal tuberosity. Resection was performed under endoscopic and fluoroscopic control for the ten cases. Proper reinsertion was verified under endoscopy, by placement of the ankle in physiological equinus for clinical series and by dissection for cadaveric cases. There were no complications in the clinical series 3 months postoperatively. CONCLUSION: Achilles enthesopathies can be treated by detachment/reinsertion of the Achilles tendon under endoscopy with resection of calcified enthesis and the calcaneal tuberosity. This endoscopic technique should now be validated by analyzing longer-term clinical and anatomical results and comparing them with the results of open surgery.