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Débridement and Repair for Insertional Achilles Tendinopathy

March 01, 2020

Contributors: Nana O Sarpong, MD; James Turner Vosseller, MD, FAAOS; Rami Alrabaa

Achilles tendinopathy usually affects middle-aged and elderly individuals. Patients with Achilles tendinopathy report posterior heel pain with swelling and stiffness. Patients with insertional Achilles tendinopathy will have tenderness at the Achilles insertion, and radiographs may reveal bony enlargement and insertional ossification of the Achilles insertion. First line nonsurgical treatment options for the management of insertional Achilles tendinopathy include activity modifications, shoe wear modifications, and physical therapy. Patients with continued symptoms after nonsurgical treatment may undergo Achilles tendon débridement and repair. The goals of surgical management of insertional Achilles tendinopathy include excision of the degenerative and tendinotic tissue, management of bony prominence or Haglund deformity, and robust fixation of the Achilles tendon back to its footprint. If a substantial portion of the tendon is removed during débridement, then tendon augmentation or transfer may be performed. This video demonstrates double-row suture anchor repair for the management of insertional Achilles tendinopathy. Some surgeons advocate double-row suture anchor repair because it is a knotless repair, has a broad contact area, and is associated with strong fixation in biomechanical studies.

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