Insertional versus non-insertional tendoachilles tears: a comparative analysis of various predisposing factors and outcome following a repair
Background Association of tendon degeneration, pre-existing posterior heel pain, Haglund’s bump, retrocalcaneal spur, and mode of injury varies for the insertional and non-insertional type of tendoachilles tears (TA). Purpose The study compares the various predisposing factors that determine the dis...
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| Published in: | International orthopaedics Vol. 46; no. 5; pp. 1009 - 1017 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01-05-2022
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Background
Association of tendon degeneration, pre-existing posterior heel pain, Haglund’s bump, retrocalcaneal spur, and mode of injury varies for the insertional and non-insertional type of tendoachilles tears (TA).
Purpose
The study compares the various predisposing factors that determine the distinct type of TA tear and the outcome following a repair.
Methods
This is a retrospective study of the patients who underwent tendoachilles repair during January 2012–June 2018. Patients above 18 years with a minimum follow-up of two years were included. Patients with calcaneal tuberosity avulsions, prior surgeries, and open injuries were excluded. Patients were divided into groups 1 (insertional tears (IT)) and 2 (non-insertional tears (NIT)), and further subdivided based on the tendon degeneration (as D-degenerative and N-normal sub types) from ultrasound findings. AOFAS score and predisposing factors like degeneration, posterior heel pain, Haglund’s bump, spur, and mechanism of injury were compared between the groups.
Results
The study included
N
= 146 with a mean age of 51.6 years and mean follow-up of 38.6 (range 24 to 96) months. IT associated with degeneration (IT-D) had a trivial fall as the predominant mechanism (
P
< 0.001). All patients had significant postoperative improvement of scores with no significant difference between the groups (
P
= 0.59) and subgroups (
P
= 0.27).75.34% had degenerative tendon, of which 64.5% were in the IT group and the rest in the NIT group (
P
= 0.02). 51.4% patients had a Haglund bump in the IT group and n.s. (
P
= 0.9). Forty-seven percent of patients had pre-existing posterior heel pain, 68% in IT and 32% in NIT (
P
= 0.04). Subgroup analysis revealed 65% of patients were in the IT-D subgroup (
P
< 0.001).
Conclusion
Predisposing factors like posterior heel pain, tendon degeneration, and trivial trauma have a strong propensity for insertional TA tear. In contrast, the prominence of Haglund’s bump does not predispose to a distinct type of TA tears. The outcome following a surgical repair–yields good results with no difference between the two groups. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0341-2695 1432-5195 |
| DOI: | 10.1007/s00264-022-05337-w |