Higher Late Heterotopic Ossification found after Endoscopic Haglund's Resection and Debridement compared to Open Treatment: A Retrospective Review

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Insertional Achilles tendinopathy (IAT) may require surgery after failed conservative treatment. Minimally invasive approaches are increasingly utilized; however, comparative outcomes regarding heterotopic ossification (HO) remain unclear. This study examines HO rates following open versus endoscopic Haglund’s resections. This study examines HO rates and pain status of the patients following open versus endoscopic Haglund’s resection and Achilles debridement. Methods: Records of 44 patients (47 surgeries) undergoing Haglund’s resection and secondary Achilles repair (36 open, 11 endoscopic) by one surgeon were retrospectively reviewed. HO (Morris KL classification) was graded preoperatively, at early (0–1.4 months), and late (≥3 months) follow-up. HO differences (ΔHO) were calculated. Visual Analog Scale (VAS) pain scores, demographics, and BMI were also collected. Results: Open-surgery patients were older (p=0.027) and had higher baseline HO (p=0.004). Early postoperative HO did not differ (p=0.445). At late follow-up, HO was significantly higher after endoscopy (p=0.021), with 63.6% versus 30.6% affected (p=0.048). The open group showed a greater HO reduction from pre- to late postoperative (ΔHO: 0.67 ± 0.48 vs. 0.09 ± 0.54; p=0.001). No significant differences were observed in BMI or VAS scores. Conclusion: Endoscopic IAT surgery demonstrated higher late HO despite comparable pain relief. Open surgery more effectively removed preexisting HO. These findings may guide surgical decision-making and postoperative care for patients with Achilles Pathology.