Surgical Takedown Approaches to Insertional Achilles Tendinopathy: A Systematic Review

• Published in: Foot & ankle orthopaedics Vol. 7; no. 1; p. 2473011421S00472
• Main Authors: Thompson, John M., McCoy, Antonio M. Malloy, Nguyen, Kevin N., Casciato, Dominick, So, Eric, Prissel, Mark A., Ahluwalia, Jaime A., Tewilliager, Tyler
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Systematic review; Achilles; Achilles Tendonopathy; Achilles Tendinosis
• ISSN: 2473-0114; 2473-0114
• DOI: 10.1177/2473011421S00472

Category:
Hindfoot
Introduction/Purpose:
Various techniques of surgical detachment for treatment of insertional Achilles tendinopathy have been described, including lateral release, medial release, central tendon splitting (CTS), and complete detachment.
Methods:
A systematic review of electronic databases was performed, encompassing 17 studies involving 703 patients and 746 feet, to compare outcomes associated with surgical takedown techniques.
Results:
Observed results include wound complication rates (CTS 2.8%; Lateral 0%; Medial 0.4%; Complete 1.3%), post-operative rupture rates (CTS 0.7%; Lateral 0.8%; Medial 0.7%; Complete 2.6%), rate of revision (CTS 0.4%; Lateral 0.9%; Medial 4.2%; Complete 2.6%), rate of infection (CTS 1.1%; Lateral 1.7%; Medial 3.7%; Complete 6.5%). Lateral takedown group was found to have a statistically significant lower rate of complications compared to the complete takedown group (p=0.0029).
Conclusion:
In light of these results, it is recommended that patient characteristics such as case specific tendon pathology and calcaneal morphology take precedent in determining the surgical approach to Achilles takedown.