Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles / Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy

OBJETIVO: La osteotomía calcánea con cuña de sustracción dorsal tiene como objetivo reducir la longitud del calcáneo, elevando la inserción del tendón de Aquiles, reduciendo así la tensión en su inserción por la verticalización del calcáneo. El objetivo del estudio es evaluar los resultados clínicos de esta osteotomía en pacientes con tendinopatía insercional de Aquiles y un ángulo de inclinación del calcáneo elevado. MATERIAL Y MÉTODOS: Estudio retrospectivo de 18 pacientes con diagnóstico de tendinopatía insercional del tendón de Aquiles. Realizamos una doble osteotomía calcánea en forma de cuña dorsal, exéresis de esta y síntesis con 2 tornillos canulados. Se evaluaron los resultados clínicos-funcionales mediante las escalas EVA, AOFAS, VISA-A y satisfacción del paciente pre- y posquirúrgicas. Los parámetros radiológicos analizados fueron el ángulo de inclinación del calcáneo, la longitud del calcáneo y ángulo de Fowler-Philips. Se realizó un análisis estadístico mediante Stata 15. La media de seguimiento fueron 18,3 meses (rango 14-36). RESULTADOS: Todos los pacientes presentaron mejoría objetiva de los síntomas y de las escalas EVA (de 8,25 a 2,16 puntos) y AOFAS (de 41,5 a 86,5 puntos) con significación estadística (p < 0,05). La persistencia de calcificaciones intratendinosas en las radiografías postoperatorias no influyó en la mejoría sintomática. CONCLUSIONES: Con los resultados obtenidos consideramos que la osteotomía calcánea con cuña de sustracción dorsal es una técnica alternativa válida en el tratamiento de la tendinopatía insercional de Aquiles, sobre todo en los casos con un ángulo de inclinación del calcáneo elevado

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy. / Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles.

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.