Long-Term Clinical Outcomes Following the Central Incision Technique for Insertional Achilles Tendinopathy

Abstract

Background: The central incision technique, more than any other exposure, allows for optimal access to the diseased Achilles tendon as well as the Haglund's prominence and the retro calcaneal bursa. We hypothesized that the central incision technique would be an effective, well-tolerated surgical incision for the surgical treatment of insertional Achilles tendinopathy with minimal to no loss of plantarflexion strength. Methods: Retrospective review of a single surgeon's experience with 27 patients, 29 surgical procedures utilizing this central approach. Isokinetic testing of plantarflexion strength, AOFAS Foot and Ankle Survey and AOFAS hindfoot score were administered to 22 patients at a mean followup time of 4 years. An additional telephone assessment was performed at a mean followup time of 7 years. Results: Average recovery time was 5.7 (range, 2 to 16) months. There was no significant difference in plantarflexion strength between the operative and nonoperative sides. At the early (4-year) assessment, 15 patients had an AOFAS hindfoot score of 100; the average AOFAS hindfoot score was 96. The long-term assessment at a mean of 7 years; 22 patients (including the two bilateral cases) reported pain scores of 0 and they had no strength deficits. Overall, there was a 96% (22 of 23) satisfaction rate. Conclusion: Surgical debridement and resection for insertional Achilles tendinopathy using the central incision technique appears to be a technically optimal procedure affording 96% pain-free patients out 7 years with minimal to no loss of strength. Level of Evidence: IV, Retrospective Case Control Study