Comparison of Lateral and Central Achilles Tendon–Splitting Approaches in the Treatment of Haglund Deformity

Abstract

Background:

This study aimed to compare the complications and outcomes of lateral and central Achilles tendon–splitting approaches for the treatment of Haglund syndrome.

Methods:

Patients who underwent surgery for Haglund syndrome between June 2012 and June 2022 were included in the study. Patients undergoing lateral approach surgery were included in group 1, whereas patients undergoing central Achilles tendon-splitting approach surgery were included in group 2. Surgical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale, visual analog pain scale (VAS), and Victorian Institute of Sport Assessment–Achilles (VISAA) scores. In addition, preoperative and final follow-up scores were compared.

Results:

The study included 66 patients: 32 (14 females, 18 males) underwent surgery using the lateral approach in group 1, whereas in group 2, 34 patients (18 females, 16 males) underwent surgery using the central Achilles tendon–splitting approach. There was a significant statistical difference in the AOFAS, VISAA, and VAS scores between preoperative and final follow-up for both group 1 and group 2 (P < .001, P < .001, P < .001, P < .001, respectively). Group 1 had a small (0.76) relative increase in VAS score compared with group 2 (P = .033). There was no significant difference between the complication rates of group 1 and group 2.

Conclusion:

In our study, we found the lateral approach and central Achilles tendon–splitting approaches to be safe and effective in the surgical treatment of Haglund syndrome without clinically meaningful differences in outcomes or complication rates.

Keywords

Achilles tendon lateral approach central approach functional scores Haglund

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References

Ahn

Byun

Kim

. Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach. J Foot Ankle Surg. 2015;54(6):1053-1056. doi:10.1053/j.jfas.2015.05.002

Calder

JDF

Saxby

. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int. 2003;24(2):119-121. doi:10.1177/107110070302400203

Chao

Deland

Bates

Kenneally

. Achilles tendon insertion: an in vitro anatomic study. Foot Ankle Int. 1997;18(2):81-84. doi:10.1177/107110079701800207

Ettinger

Razzaq

Waizy

, et al Operative treatment of the insertional Achilles tendinopathy through a transtendinous approach. Foot Ankle Int. 2016;37(3):288-293. doi:10.1177/1071100715609921

Geng

, et al Anatomy of the sural nerve with an emphasis on the incision for medial displacement calcaneal osteotomy. J Foot Ankle Surg. 2015;54(3):341-344. doi:10.1053/J.JFAS.2014.07.008

Gillis

Lin

. Use of a central splitting approach and near complete detachment for insertional calcific Achilles tendinopathy repaired with an Achilles bridging suture. J Foot Ankle Surg. 2016;55(2):235-239. doi:10.1053/J.JFAS.2015.10.002

Hörterer

Baumbach

Oppelt

, et al Complications associated with midline incision for insertional Achilles tendinopathy. Foot Ankle Int. 2020;41(12):1502-1509. doi:10.1177/1071100720943836

Jiang

Wang

, et al Lateral approach for insertional Achilles tendinitis with Haglund deformity. Front Surg. 2023;9:1063833. doi:10.3389/FSURG.2022.1063833

Johnson

Zalavras

Thordarson

. Surgical management of insertional calcific achilles tendinosis with a central tendon splitting approach. Foot Ankle Int. 2006;27(4):245-250. doi:10.1177/107110070602700404

10.

Jones

. Retrocalcaneal bursitis and insertional Achilles tendinitis. Sports Med Arthrosc Rev. 1994;2:301-309.

11.

Kang

Thordarson

Charlton

. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int. 2012;33(6):487-491. doi:10.3113/FAI.2012.0487

12.

Maffulli

Sharma

Luscombe

. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004;97(10):472-476. doi:10.1177/0141076809701004

13.

McGarvey

Palumbo

Baxter

Leibman

. Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int. 2002;23(1):19-25. doi:10.1177/107110070202300104

14.

Natarajan

Narayanan

. Haglund deformity - surgical resection by the lateral approach. Malays Orthop J. 2015;9(1):1-3. doi:10.5704/MOJ.1503.006

15.

Nunley

Ruskin

Horst

. Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int. 2011;32(9):850-855. doi:10.3113/FAI.2011.0850

16.

Schepsis

Wagner

Leach

. Surgical management of Achilles tendon overuse injuries. A long-term follow-up study. Am J Sports Med. 1994;22(5):611-619. doi:10.1177/036354659402200508

17.

Sella

Caminear

McLarney

. Haglund’s syndrome. J Foot Ankle Surg. 1998;37(2):110-114. doi:10.1016/S1067-2516(98)80089-6

18.

Vaishya

Agarwal

Azizi

Vijay

. Haglund’s syndrome: a commonly seen mysterious condition. Cureus. 2016;8(10):e820. doi:10.7759/CUREUS.820

19.

Wagner

Gould

Kneidel

Fleisig

Fowler

. Technique and results of Achilles tendon detachment and reconstruction for insertional Achilles tendinosis. Foot Ankle Int. 2006;27(9):677-684. doi:10.1177/107110070602700904

20.

Watson

Anderson

Davis

. Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional achilles tendinosis with calcific spur. Foot Ankle Int. 2000;21(8):638-642. doi:10.1177/107110070002100802

21.

Xia

Yew

AKS

Zhang

HCD

YCS

Rikhraj

. Surgical correction of Haglund’s triad using a central tendon-splitting approach: a retrospective outcomes study. J Foot Ankle Surg. 2017;56(6):1132-1138. doi:10.1053/J.JFAS.2017.05.015

22.

Yuen

WLP

Tan

Kon

KKC

. Surgical treatment of Haglund’s deformity: a systematic review and meta-analysis. Cureus. 2022;14(7):e27500. doi:10.7759/CUREUS.27500

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