Clinical Outcomes of Minimally Invasive Zadek Osteotomy Used to Treat Insertional Achilles Tendinopathy

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: A suite of surgical interventions exist for insertional Achilles tendinopathy (IAT) including a recent percutaneous approach to the Zadek dorsal closing wedge osteotomy (ZO). The percutaneous ZO shows promising outcomes compared to traditionally open-approach interventions. In this study, we conducted a retrospective cohort analysis to assess patient outcomes and complications of a percutaneous ZO in patients with IAT. Methods: We retrospectively analyzed 30 consecutive patients with a minimum of 1 year follow-up who underwent percutaneous ZO to treat IAT. Patient Reported Outcome Measures (PROMs) such as the Foot and Ankle Ability Measure (FAAM), PROMIS global health, and the Visual Analog Scale (VAS) score were evaluated to document patient physical function, overall health and pain, respectively. Patients were evaluated at 6 weeks, 3 months, 6 months, and 1 year follow-up visits. Results: Mean follow up was 30.91 weeks (± 7.2). Mean patient age was 57.8 (± 11.2) years and mean BMI was 31.6 (± 6.9). The average FAAM sports score improved from 30.7 (± 23.7) to 51.8 (± 37.1) postoperatively (P < 0.05). Mean VAS score improved from 6.3 (± 4.1) to 3.2 (± 1.8) postoperatively (P < 0.05). No significant improvement was found in the FAAM-ADL, PROMIS-GMH or PROMIS-GPH categories. The overall complication rate was 10% (3) including 2 superficial skin infections, 2 resolved with antibiotics and debridement, and 1 hardware removal, which was done to avoid progression of a superficial skin infection to a deep wound infection. Conclusion: The percutaneous ZO is a viable and safe intervention for treatment of patients with IAT at 1 year follow-up. Our study revealed minimal complications and improvements in athletic function and pain levels for patients. Although limited to PROMS, our results nonetheless indicate encouraging outcomes as pain relief is a key outcome of focus for patients being treated for IAT. Additional comparative studies are necessary to confirm the full efficacy of this treatment.