Bone-Tendon Autograft In Insertional Achilles Tendinopathy Treatment
Author(s):
Feranec M. (Czech Republic)
,
Feranec M. (Czech Republic)
Affiliations:
Hart R.
,
Hart R.
Affiliations:
Sanalla H.
Sanalla H.
Affiliations:
ESSKA Academy. Feranec M. 05/09/18; 209211; P01-122 Topic: Open Surgery
Martin Feranec
Martin Feranec
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Abstract
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Objectives: Insertional Achilles tendinopathy is characterized by the amorphous scar tissue present in the tendon by its insertion to the calcaneus. Its excision and augmentation of the repair has been recommended when more than half of the tendon has been resected. Different augmentations have been described. The aim of our prospective study was to assess results after the usage of the bone-tendon autograft harvested from the quadriceps tendon.

Methods: Between 2012 and 2014, 13 patients underwent resection of more than 50 % of tendon diameter in its insertion because of tendinopahy confirmed on MRI. The bone-tendon quadriceps graft was harvested using minimally invasive instrumentation. After the resection of amorphous tissue, the dock was drilled in the dorsal aspect of the calcaneus, the bone block of was fixed in the dock with an interference screw and the tendinous part of the graft was sutured side-to-side to the remaining Achilles tendon. Immobilisation in the cast followed for 6 weeks and then partial weight-bearing started for another 6 weeks. The nonparametric Wilcoxon test was used to evaluate results.

Results: In all cases the good function of the Achilles tendon was observed in at least 2 years follow-up. All patients were satisfied. In 4 cases wound healing problems were observed. Kitaoka Score improved from 47,4 to 90,3 points, AOFAS Score from 46,4 to 89,8 points, and VAS from 8,3 to 1,9 points at average (p < 0,05).

Conclusions: The bone-tendon autograft augmentation seems to be a rational solution for the treatment of the insertional Achilles tendinopathy. Further investigation is necessary to confirm this statement.

Keywords:
Achilles Tendon; Insertional Tendinopathy
Objectives: Insertional Achilles tendinopathy is characterized by the amorphous scar tissue present in the tendon by its insertion to the calcaneus. Its excision and augmentation of the repair has been recommended when more than half of the tendon has been resected. Different augmentations have been described. The aim of our prospective study was to assess results after the usage of the bone-tendon autograft harvested from the quadriceps tendon.

Methods: Between 2012 and 2014, 13 patients underwent resection of more than 50 % of tendon diameter in its insertion because of tendinopahy confirmed on MRI. The bone-tendon quadriceps graft was harvested using minimally invasive instrumentation. After the resection of amorphous tissue, the dock was drilled in the dorsal aspect of the calcaneus, the bone block of was fixed in the dock with an interference screw and the tendinous part of the graft was sutured side-to-side to the remaining Achilles tendon. Immobilisation in the cast followed for 6 weeks and then partial weight-bearing started for another 6 weeks. The nonparametric Wilcoxon test was used to evaluate results.

Results: In all cases the good function of the Achilles tendon was observed in at least 2 years follow-up. All patients were satisfied. In 4 cases wound healing problems were observed. Kitaoka Score improved from 47,4 to 90,3 points, AOFAS Score from 46,4 to 89,8 points, and VAS from 8,3 to 1,9 points at average (p < 0,05).

Conclusions: The bone-tendon autograft augmentation seems to be a rational solution for the treatment of the insertional Achilles tendinopathy. Further investigation is necessary to confirm this statement.

Keywords:
Achilles Tendon; Insertional Tendinopathy
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