Category: Ankle, Sports
Keywords: Achilles Tendinopathy, Achilles Tendon, PROMIS
Introduction/Purpose: Surgical management of Insertional Achilles Tendinopathy (IAT), often associated with a Haglund’s deformity, involves debridement of the diseased tendon and resection of the Haglund’s deformity. This has historically been performed via an open approach. Given risks including large incisions, wound healing complications and longer recovery times, minimally invasive (MIS) Achilles debridement and Haglund’s resection techniques have been developed to minimize recovery time and wound healing complications. However, literature is scarce regarding outcomes of these MIS techniques. This study compares patient-reported outcome scores (PROMIS Physical Function and Pain Interference scores) for patients undergoing open versus MIS Achilles debridement and Haglund’s resection to determine if there is a significant difference in patient outcomes between MIS and open approaches to surgical management of IAT.
Methods: Patients over 18 years of age undergoing open or MIS Achilles debridement and Haglund’s resections by four fellowship-trained Foot & Ankle surgeons at a single institution were identified between March 2018 and February 2025 after Institutional Review Board (IRB) approval was obtained. Demographic data as well as preoperative and postoperative patient-reported outcome (PROMIS Physical Function and Pain Interference) scores for function and pain were collected. Postoperatively, PROMIS scores were collected at two weeks, six weeks, three months, six months, one year and at final follow-up. Patients with less than six months of postoperative follow-up were excluded. Statistical analysis was performed using Microsoft Excel and MATLAB. Independent samples t-tests were performed with significance set at p<0.05.
Results: 20 patients in the MIS group and 26 patients in the open group were included. Mean age was 52.65 years for the MIS group and 50.92 years for the open group. Mean BMI was 36.64 for the MIS group and 32.46 for the open group (p=0.034). Preoperative PROMIS Physical function and Pain Interference scores were not significantly different between groups. Postoperatively, PROMIS Physical Function scores at six weeks were higher for patients in the MIS group (36.75 vs 26.73, p<0.001). At all other time points, PROMIS scores were not significantly different between groups. One patient in the open group sustained an Achilles avulsion postoperatively, and no Achilles avulsions or ruptures were sustained in the MIS group.
Conclusion: MIS Achilles debridement and Haglund’s resection results in similar postoperative patient- reported outcomes to standard open approaches. At six weeks postoperatively, patients who had undergone MIS surgery reported better functional outcomes as compared to the open group, with no differences in outcomes at all other time points. No Achilles ruptures were noted in the MIS group. MIS approaches to treatment for IAT are a viable alternative to classic open approaches, with promising patient-reported outcomes postoperatively.
AbstractFirst published online January, 2026
