Percutaneous Debridement and Double-Row Repair for Insertional Achilles Tendinopathy With Immediate Postoperative Weightbearing: A Consecutive Case Series

Abstract

Background:

Percutaneous treatment of insertional Achilles tendinopathy is gaining popularity. The objectives of this study were to show that a percutaneous double-row repair technique with immediate postoperative weightbearing (1) allows safe access to both the Haglund deformity and the Achilles enthesophyte with radiographic resolution of pathology and (2) was associated with clinical outcomes with no early weightbearing-related complications.

Methods:

A retrospective cohort study was conducted of consecutive patients. Correction was accomplished with an MIS burr and double-row repair technique through percutaneous incisions with fluoroscopic assistance. Patients were allowed to immediately weight-bear in a pneumatic walking boot with four 5° wedges (totaling 20° wedge) with progressive near-weekly wedge removal until return to normal shoes at 5.5 weeks. Patient demographic data and intraoperative data were recorded, as were pre- and postoperative patient-reported outcomes, radiographic measures, and short-term complications.

Results:

Sixty-one consecutive patients were included with a mean follow-up of 12.1 ± 5.7 months (range, 1.5-24 months). Preoperative mean spur length and width improved from 14.29 (SD 7.38) mm and 5.88 (SD 2.49) mm to 0 mm postoperatively in all patients (P < .05). Spur-to-skin distance improved from 7.38 (SD 2.00) mm to 14.76 (SD 3.57) mm (P < .05). Mean FADI increased from 56.30 (95% CI, 52.9-59.7) to 96.82 (95% CI, 95.3-98.3) (P < .05) at the 12-month follow-up, and mean VAS decreased from 7.25 (95% CI, 7.01-7.49) preoperatively to 0.47 (95% CI, 0.17-0.77) at 12 months. No patients required repeat surgery, and there were no postoperative Achilles tendon ruptures. Eleven patients reported minor complications within 3 months of surgery.

Conclusion:

The findings of this study suggest that percutaneous insertional Achilles debridement and repair using a double-row repair technique with immediate weightbearing was associated with improvement in radiographic parameters and patient-reported outcomes through 12 months, with no postoperative tendon ruptures, no revision surgery, and a low overall complication rate.

Level of Evidence:

Level IV, retrospective case series.

Keywords

MIS double-row repair insertional Achilles tendinopathy Achilles insertional tendinosis percutaneous treatment of insertional Achilles pathology

Introduction

Insertional Achilles tendinopathy (IAT) is a frequent cause of posterior heel pain in active adults. When nonoperative care fails, operative goals are to decompress the retrocalcaneal space, excise impinging bone, debride degenerative tendon, and restore a durable tendon-bone interface while minimizing soft tissue morbidity.¹ The historical gold standard has been an open technique, most often with a central tendon split, debridement, and then repair as described by McGarvey et al.² This has achieved good to excellent patient-reported outcomes and return to activity in the majority of patients.^2-8

Recently, percutaneous techniques such as the Zadek osteotomy^9,10 and minimally invasive knotless double-row “suture-bridge” constructs¹¹ have gained traction because they preserve the posterior soft tissue envelope. By reducing dissection and protecting vascularity, these approaches are inherently aligned with earlier functional progression and fewer wound-related setbacks.^11,12 The Zadek has achieved clinically meaningful improvement in outcomes, pain, and function.^13-17

Although a robust literature favorably supports double-row repair in open IAT surgery, there is limited evidence specifically addressing percutaneous applications especially paired with immediate weightbearing as tolerated (WBAT) after insertional debridement and reattachment.^18-20 This gap is particularly relevant in patients with coexisting Haglund prominence and enthesophytes, where comprehensive access and secure reattachment must be balanced against soft tissue risk and recovery speed.²¹

To address this gap, we report a cohort who underwent a percutaneous double-row repair technique that safely accesses both the Haglund deformity and the Achilles enthesophyte and implements a standardized immediate-WBAT protocol. The objectives of this study were to show that the technique (1) allows safe access to both the Haglund deformity and the Achilles enthesophyte with improved postoperative radiographic parameters and (2) has improved clinical outcomes with no early weightbearing-related complications, including no Achilles tendon ruptures or return to the operating room. We hypothesized that this approach would yield meaningful improvements in radiographic measures and patient-reported outcomes and radiographic parameters with low complication, rerupture, and revision rates.

Methods

Study Design

After obtaining institutional review board approval, a retrospective review of a single fellowship-trained foot and ankle surgeon’s cohort of patients was conducted. The patients underwent a percutaneous insertional Achilles tendon debridement and double-row repair with SpeedBridge (Arthrex, Naples, FL)²² technique as described below. Patient demographic data and intraoperative data, including tourniquet and fluoroscopy time, were recorded. The functional outcomes of patients were evaluated using the Foot and Ankle Disability Index (FADI) at preoperative, 3-month, 6-month, 12-month, and 24-month postoperative time points, and visual analog scale (VAS) scores were collected at preoperative, 1.5-month, 3-month, 6-month, 12-month, and 24-month follow-ups. Pre- and postoperative radiographic measures, including spur length, spur width, and spur-to-skin distance, were obtained using standardized lateral radiographs by a single foot and ankle fellowship-trained orthopaedic surgeon. Spur length was defined as the maximal posterior calcaneal projection, and spur width was measured at its widest dimension. Spur-to-skin distance was measured as the shortest distance from the posterior calcaneal cortex to the overlying skin. Short-term complications were recorded including reoperations, tendon ruptures, deep vein thrombosis (DVT), and superficial wound dehiscence requiring antibiotics.

Patients were included if they were adults (≥18 years) diagnosed with insertional Achilles tendinopathy who failed a minimum of 3-6 months of nonoperative management, including activity modification, physical therapy, heel lifts or orthotics, and/or anti-inflammatory treatment. Surgical indication was based on persistent pain and functional limitation refractory to conservative care, in conjunction with radiographic evidence of insertional pathology, including Haglund deformity and/or calcaneal enthesophyte.

Patients were excluded if they had acute Achilles tendon rupture, prior Achilles tendon reconstruction with tendon transfer, active infection, neuromuscular disorders affecting lower extremity function, or insufficient clinical follow-up (<6 weeks).

The minimally invasive percutaneous approach was selected based on surgeon preference and suitability for achieving adequate access to both the Haglund deformity and calcaneal enthesophyte without extensile exposure. No patients meeting surgical criteria during the study period were treated with an open technique by the operating surgeon.

Five patients with prior open debridement were included as revision cases. These patients were retained to reflect real-world clinical practice and to evaluate the feasibility of the percutaneous technique in both primary and revision settings. Subgroup analysis was not performed because of limited sample size, and this was considered a limitation of the study.

Surgical Technique

Sample preoperative radiographs are shown in Figure 1A with radiographic measures marked. The patient was placed in a prone position, and a thigh tourniquet was applied. For cases where a tourniquet was used, it was inflated at the start of the case. Four small portal incisions were made: 1 each at the proximal medial and proximal lateral borders of the Achilles insertion, and 1 additional portal on each side of the Achilles insertion. A small curved hemostat was used through all 4 portals to elevate soft tissue from the dorsal calcaneus and remove any skin bridging. A sharp elevator was then placed deep to the Achilles tendon to separate the tendon from the enthesophyte and Haglund deformity, switching portals multiple times. The Shannon burr was then introduced, and the Haglund deformity was reduced under fluoroscopic guidance. The surrounding bursa was removed as well, and then the area was gently irrigated and suctioned to remove bony debris.

Figure 1.

(A) Preoperative radiograph of patient with Haglund deformity and insertional Achilles tendinitis with radiographic measures shown. (B) Postoperative radiograph, postpercutaneous debridement of Haglund deformity, and Achilles enthesophyte with radiographic measures shown.

The burr was then introduced through the distal medial and lateral incisions, and the central calcaneal enthesophyte was meticulously taken down using fluoroscopy for assistance. A small rasp was used and then the area was irrigated again and suctioned gently to remove bony debris.

Then attention was turned to repair of the Achilles. Guidewires were inserted into the distal medial and distal lateral incisions under fluoroscopic guidance, drilled, and tapped with guidewires left in place (Figure 2). The proximal incisions were then used to drill and place 2 all-suture anchors (1 medial and 1 lateral) directly at the Achilles proximal footprint/insertion using fluoroscopic guidance (Figure 3). The rip stop mechanism is shuttled from the portal through the Achilles and then out the skin both medially and laterally. This process was completed again with the suture tapes. The sutures are then shuttled out medially and laterally between the Achilles tendon and the skin at the layer previously developed with the hemostat. The rip stop was then shuttled, and a locked rip stop suture construct was created and sequentially tightened. This created a new footprint and a very secure proximal row. Finally, suture tapes were shuttled in a crossing fashion to establish a speed bridge construct and tensioned with the foot in 10° to 15° of plantarflexion. Distal medial and lateral screws were inserted to complete the repair construct. Local anesthetic (combination of lidocaine and ropivacaine) was injected. No regional blocks were used to ensure that immediate weightbearing could be achieved. Portals were closed with 3-0 nylon.

Figure 2.

(A) Radiographic image of calcaneal guidewires in position with tap sleeve in place. (B) Intraoperative image of tapping over calcaneal guidewire.

Figure 3.

Intraoperative images of placing all-suture anchors at the proximal Achilles insertion/footprint with guidewires remaining in place for future distal fixation.

All debridement was completed percutaneous with a Shannon burr and mini C-arm fluoroscopy. No tendon transfers or gastrocnemius recessions were completed.

Postoperative Course

All patients were allowed to be weightbearing immediately postoperatively in a CAM pneumatic walking boot with four 5° wedges (totaling 20° wedge) in place. Every 1-1.5 weeks, one of the wedges was removed until return to normal shoes occurred at 5.5 weeks. Sample postoperative radiographs are shown in Figure 1B with postoperative radiographic measurements marked.

Statistical Analysis

Longitudinal patient-reported outcomes, including FADI and VAS scores, were analyzed using linear mixed-effects models with time treated as a fixed effect. To account for repeated measures and inter-individual variability in recovery trajectories, both random intercepts and random slopes for time were included at the patient level.

Model fit was evaluated by comparing models with random intercepts alone versus models including both random intercepts and slopes using Akaike information criterion (AIC), Bayesian information criterion (BIC), and likelihood ratio testing. For both FADI and VAS outcomes, inclusion of random slopes significantly improved model fit (P < .05), and these models were therefore selected for final analysis (Figure 4).

Figure 4.

(A) Mean Foot and Ankle Disability Index (FADI) scores from preoperative baseline through 24-month follow-up. (B) Mean visual analog scale (VAS) pain scores from preoperative baseline through 24-month follow-up. Error bars represent SDs. Both panels demonstrate significant improvements in functional outcomes and pain reduction over time following the procedure (P < .001 for overall time effects). The x axis denotes postoperative follow-up intervals, and the y axes depict the respective scales for FADI (0-100) and VAS (0-10).

This approach allowed inclusion of all available data across time points while accounting for heterogeneity in longitudinal response patterns. Inclusion of random slopes did not materially alter the direction or statistical significance of the fixed time effects for either outcome.

Paired-samples t tests were used for select preoperative and postoperative comparisons where appropriate. Categorical variables were compared using chi-squared analysis. Statistical significance was set at P <.05.

Follow-up duration varied across patients because of the retrospective design and staggered timing of surgical cases. At the time of data collection, not all patients had reached each postoperative time point, resulting in differing numbers of observations at each interval. All patients were eligible for follow-up, but later time points include only those who had reached the corresponding postoperative duration. Mixed-effects modeling was used to account for unequal follow-up durations and repeated measures within patients.

Given the retrospective single-cohort design and absence of a pre-specified primary outcome, all analyses were considered exploratory in nature.

Results

Participants and Demographics

Sixty-one consecutive patients were included in the study with a mean age of 53.54 ± 9.64; 37 patients (60.66%) were females, and the mean body mass index (BMI) was 38.86 ± 13.15. Six patients (9.8%) were nicotine users. Five (8.2%) of the patients had revisions surgeries (Table 1). Mean tourniquet time and fluoroscopy time were 41.6 ± 15.0 minutes and 69.0 ± 38.8 seconds, respectively.

Table 1.

Descriptive Data (n = 61 Patients).

Characteristic	Mean ± SD (Range) or n (%)
Age, y	53.4 ± 9.6 (26-68)
Sex, female	37 (60.7)
Body mass index	38.9 ± 13.2
Diabetes	6 (9.8)
Nicotine	6 (9.8)
Tourniquet time^a	41.6 ± 15.0 (29-90)
Fluoroscopy time	69.0 ± 38.8 (19.0-202.8)
Follow-up, mo	12.1 ± 5.7 (1.5-24)
Revision surgeries	5 (8.2)

Four cases were performed without a tourniquet.

Radiographic Outcomes

Radiographic measures regarding spur length, width, and spur to skin measurements are presented in Table 2. Mean preoperative spur length and width were 14.29 ± 7.38 mm and 5.88 ± 2.49 mm, respectively. Postoperatively, both spur length and width were corrected to 0 mm in all patients (P < .001), indicating complete radiographic resolution of the calcaneal spur following repair. Additionally, the mean spur-to-skin distance increased from 7.38 ± 2.00 mm preoperatively to 14.76 ± 3.57 mm postoperatively. A paired-samples t-test revealed statistically significant improvement across all radiographic parameters (P < .001).

Table 2.

Radiographic Measures.

Measure	Preoperative,Mean ± SD	Postoperative,Mean ± SD
Spur length	14.29 ± 7.38	0
Spur width	5.88 ± 2.49	0
Spur to skin measurements	7.38 ± 2.00	14.76 ± 3.57

Patient-Reported Outcomes

FADI scores were available for 61 patients preoperatively, 57 patients at 3 months, 56 patients at 6 months, 45 patients at 12 months, and 9 patients at 24 months. FADI demonstrated a significant effect of time, Wald χ²(4) = 457.70 (P < .001), improving from 56.30 (95% CI, 52.9-59.7) preoperatively to 82.33 (95% CI, 78.5-86.1) at 3 months, 87.84 (95% CI, 84.0-91.6) at 6 months, 96.82 (95% CI, 95.3-98.3) at 12 months, and 98.00 (95% CI, 96.0-100.0) at 24 months (Table 3). Compared with baseline, FADI increased significantly at 3, 6, 12, and 24 months (all P < .001), with continued improvement from 3 to 6 months (P = .005) and from 6 to 12 months (P < .001), and with the numbers available, no significant difference could be detected from 12 to 24 months (P = .75). The number of patients contributing data at each postoperative time point reflects those who had reached the corresponding follow-up interval at the time of data collection, rather than loss to follow-up. At 12 months, outcome data were available for 45 patients who had reached this time point.

Table 3.

FADI and VAS Scores Following Double-Row Suture Bridge.

Timepoint^a	FADI (Mean ± SD)	n	95% CI	VAS (Mean ± SD)	n	95% CI
Preoperative	56.30 ± 13.14	61	52.9-59.7	7.25 ± 0.95	60	7.01-7.49
1.5 mo	—	—	—	1.59 ± 1.71	60	1.15-2.03
3 mo	82.33 ± 14.42	57	78.5-86.1	1.72 ± 1.82	57	1.24-2.20
6 mo	87.84 ± 14.26	56	84.0-91.6	1.55 ± 2.04	55	1.01-2.09
12 mo	96.82 ± 5.13	45	95.3-98.3	0.47 ± 1.01	45	0.17-0.77
24 mo	98.00 ± 2.60	9	96.0-100.0	0.00 ± 0.00	9	0.00-0.00

Abbreviations: FADI, Foot and Ankle Disability Index; VAS, visual analog scale.

The number of patients contributing data at each postoperative time point reflects those who had reached the corresponding follow-up interval at the time of data collection, rather than loss to follow-up. Both score follow-ups demonstrate significant improvements in functional outcomes and pain reduction over time following the procedure (P < .001 for overall time effects).

VAS scores were available for 61 patients preoperatively, 61 patients at 1.5 months, 57 patients at 3 months, 55 patients at 6 months, 45 patients at 12 months, and 9 patients at 24 months. VAS demonstrated a significant effect of time (P < .001), decreasing from 7.25 (95% CI, 7.01-7.49) preoperatively to 1.59 (95% CI, 1.15-2.03) at 1.5 months, 1.72 (95% CI, 1.24-2.20) at 3 months, 1.55 (95% CI, 1.01-2.09) at 6 months, 0.47 (95% CI, 0.17-0.77) at 12 months, and 0 at 24 months (all 9 patients with 24-month VAS scores reported no pain). Compared with baseline, pain scores were significantly reduced at all postoperative time points (all P < .001). The number of patients contributing data at each postoperative time point reflects those who had reached the corresponding follow-up interval at the time of data collection, rather than loss to follow-up. At 12 months, outcome data were available for 45 patients who had reached this time point.

FAD and VAS data were available for all patients preoperatively and variably available at postoperative time points depending on whether patients had reached the corresponding follow-up interval.

Postoperative Complications

No patients required revision surgery, and there were no postoperative Achilles tendon ruptures. A total of 11 patients (18.0%) experienced minor complications within 3 months of surgery. One patient (1.6%) developed a superficial wound infection that resolved with oral antibiotics, and 2 patients (3.2%) developed deep vein thromboses that were successfully managed without progression to pulmonary embolism. Six patients (9.8%) reported mild central numbness over the Achilles tendon, 1 patient (1.6%) experienced localized tenderness to palpation at the posterolateral portal, and 1 patient reported an injury to the lateral calcaneal branch of the sural nerve that did not resolve. All complications were transient and resolved with conservative management, with the exception of permanent nerve injury. A summary of postoperative complications is presented in Table 4.

Table 4.

Postoperative Complications (n = 61).^a

Variable	No. (%) of Patients
Superficial wound infection	1 (1.6)
Deep vein thrombosis	2 (3.2)
Central numbness over the Achilles tendon	6 (9.8)
Tenderness to palpation	1 (1.6)
Sural nerve	1 (1.6)

Summary of postoperative complications within 3 months of surgery. All complications were minor and resolved with conservative management. No patients required revision surgery or experienced Achilles tendon rupture.

No clear association was observed between the occurrence of complications and patient demographic variables, including age and body mass index, or intraoperative variables such as tourniquet time and fluoroscopy time. Additionally, patients who experienced complications demonstrated similar improvements in FADI and VAS scores compared with those without complications, and no differences in radiographic outcomes were observed. Given the small number of complication events, no formal subgroup statistical analysis was performed.

Discussion

Our retrospective cohort is the first clinical series describing a fully percutaneous system for insertional Achilles debridement and double-row tendon repair combined with immediate postoperative weightbearing. The first main finding of the present study is that this technique reliably allowed percutaneous access to both the posterosuperior calcaneal prominence and the Achilles enthesophyte with complete radiographic correction. In addition to restoring calcaneal topographic anatomy, patients were permitted WBAT on postoperative day zero in a controlled boot protocol, avoiding casting and prolonged immobilization. Patient-reported outcomes improved substantially over time, with the largest reduction in pain observed early postoperatively and functional gains maintained among patients with longer-term follow-up data. Despite accelerated rehabilitation, there were no postoperative Achilles tendon ruptures, no return to the operating room, and only a low rate of minor complications.

Open surgical treatment has historically been regarded as the standard operative approach for insertional Achilles tendinopathy and has demonstrated consistent improvements in radiographic measures and clinical outcomes like pain and function.^2-8 However, these outcomes have frequently been achieved at the expense of extensive soft tissue dissection, prolonged immobilization, and delayed return to activity. Traditional open techniques often involve a central tendon split and postoperative splinting or casting for several weeks, followed by extended use of a walking boot.² During this period of immobilization, patients are susceptible to muscle atrophy, stiffness, and delayed functional recovery, factors that have been associated with prolonged rehabilitation and patient dissatisfaction.^6,23,24 The fully open approach also involves a significant risk of wound healing complications, which is particularly concerning in the area of the Achilles tendon where soft tissue coverage is already a premium.^9,15,25-28 In contrast, the fully percutaneous approach described in this study preserves the posterior soft tissue envelope while achieving complete osseous and tendinous correction, permitting immediate weightbearing with a boot. This strategy was associated with rapid early recovery, as evidenced by significant improvements in pain and functional scores within the first 3 months postoperatively that are maintained at 12 months postoperatively.

The broader shift toward minimally invasive strategies for treating IAT can be seen through the increasing adoption of the Zadek osteotomy, and this is largely driven by efforts to reduce wound complications associated with open surgery.^9,15,25-28 The Zadek procedure employs a dorsal closing-wedge calcaneal osteotomy to rotate the posterosuperior calcaneus anteriorly, thereby increasing retrocalcaneal space and reducing tendon impingement.^26-28 Multiple series have demonstrated improvements in patient-reported outcomes following the Zadek osteotomy.^26-28 In the widely cited series by Georgiannos et al,²⁶ the Zadek osteotomy is stabilized using one or two large compression screws following dorsal closing-wedge resection of the calcaneus. Although this construct effectively alters calcaneal morphology and reduces impingement, percutaneous large screw fixation directly through the disease Achilles tendon insertion and associated enthesophyte contributes further to a dysmorphic function. From a biomechanical standpoint, this raises concern that additional stress at an already compromised tendon-bone interface may contribute to persistent insertional symptoms or delayed recovery, particularly when compared with techniques that directly excise diseased tissue and avoid transosseous fixation at the insertion.^29,30 Although the Zadek osteotomy is associated with lower wound complication rates than traditional open approaches, it introduces risks inherent to osteotomy, including calcaneal nonunion, which has been reported in approximately 3% to 4% of cases and often necessitates revision surgery.³¹ In contrast, the percutaneous technique described in the present study directly addresses both the Haglund deformity and Achilles enthesophyte without osteotomy, thereby eliminating the risk of nonunion; notably, no patients in our cohort required reoperation.

Our technique enables significant improvement of radiographic parameters that are not modified in other minimally invasive techniques. Complete elimination of both the posterosuperior calcaneal prominence and the Achilles enthesophyte was confirmed radiographically in all patients. Similar radiographic goals have traditionally required open exposure, as demonstrated by Greiner et al,⁵ who reported reliable correction of posterosuperior calcaneal pathology using an open double-row refixation technique. Therefore, our study challenges the prevailing belief that adequate resection of the enthesophyte cannot be achieved through minimally invasive techniques alone.^3,12 Spur-to-skin distance also increased significantly following surgery, a radiographic parameter that has been shown to correlate inversely with pain reduction in patients with insertional Achilles pathology.^16,25 The magnitude of improvement observed in this cohort is comparable to that reported following open correction, suggesting that similar anatomic restoration can be achieved through a fully percutaneous approach.^5,7

After achieving these corrections intraoperatively, accelerated recovery is begun with immediate WBAT beginning on postoperative day zero, which is a key distinguishing feature of this technique. Prior studies evaluating double-row suture bridge constructs in insertional Achilles repair have demonstrated that stable fixation can safely support early functional loading.^19,20 Specifically, Rigby et al²⁰ reported outcomes in a cohort of 43 patients who underwent insertional Achilles repair using a suture-bridge construct with early weightbearing, with no postoperative Achilles tendon ruptures or fixation failures observed. In the present cohort, accelerated rehabilitation was not associated with tendon rupture, fixation failure, or need for revision surgery. Although 2 patients developed postoperative deep vein thrombosis, complications were otherwise minor and self-limited. Formal physical therapy was not routinely required, reflecting both construct stability and the ability of patients to progress functionally without aggressive early intervention. These findings support the feasibility and safety of immediate weightbearing following percutaneous insertional Achilles debridement and repair.

We acknowledge the limitations of our study. Its retrospective design and lack of a control group limit direct comparison with alternative operative techniques and preclude causal inference regarding superiority. Because of the retrospective design and staggered timing of surgical cases, not all patients had reached longer-term follow-up intervals at the time of data collection. At 12 months, outcome data were available for 45 patients who had reached this time point. Patients with shorter follow-up durations were included in the longitudinal analyses through mixed effects modeling, allowing incorporation of all available data. However, inclusion of patients who had not yet reached 12 months of follow-up may limit the reliability of long-term outcome conclusions and introduces potential bias in estimating sustained functional recovery. Additionally, the limited number of patients at later time points, particularly at 24 months, reduces the precision of long-term estimates. Radiographic results greater than 12 months demonstrate small bone islands within the Achilles insertion that remain unclassified and difficult to quantify. Radiographic measurements were performed by a single fellowship-trained foot and ankle surgeon, and inclusion of multiple independent reviewers may improve generalizability. Additionally, no validated minimum clinically important difference for the FADI has been established in the insertional Achilles tendinopathy population, which limits the ability to quantify individual-level clinical meaningfulness of the observed functional improvements. Finally, the findings of this study should be interpreted as exploratory and hypothesis-generating rather than confirmatory.

Conclusion

In this exploratory retrospective series, percutaneous insertional Achilles debridement and double-row repair with immediate postoperative weightbearing was associated with significant improvements in radiographic parameters and patient-reported outcomes through 12 months, with no postoperative tendon ruptures, no revision surgery, and a low overall complication rate. These findings support the feasibility of this technique and provide a basis for prospective comparative study.

Supplemental Material

sj-pdf-1-fao-10.1177_24730114261457084 – Supplemental material for Percutaneous Debridement and Double-Row Repair for Insertional Achilles Tendinopathy With Immediate Postoperative Weightbearing: A Consecutive Case Series

Supplemental material, sj-pdf-1-fao-10.1177_24730114261457084 for Percutaneous Debridement and Double-Row Repair for Insertional Achilles Tendinopathy With Immediate Postoperative Weightbearing: A Consecutive Case Series by Kevin D. Martin, Srihan Anand and W. Alexander Cantrell in Foot & Ankle Orthopaedics

Footnotes

ORCID iD

Kevin D. Martin, DO,

Ethical Considerations

The Ohio State University Office of Responsible Research Practices determined that the project was exempt from institutional review board approval.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Kevin D Martin, DO, reports disclosures relevant to manuscript of consult for Arthrex, ConMed, and XO Armor. Disclosure forms for all authors are available online.

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