Long-Term Follow-Up after Calcaneoplasty: Does it Really Work?

Research Type: Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results Introduction/Purpose: Haglund syndrome is characterized by a triad of posterosuperior calcaneal prominence, retrocalcaneal bursitis, and insertional Achilles tendinopathy. Several operative approaches have been described, and both open and endoscopic approaches are reliable and feasible. Open surgery is associated with a higher rate of delayed skin healing, persistent pain, and stiffness. Endoscopic surgery requires longer operative duration and costs. Endoscopic surgery produces final results equal to or better than those of an open technique, with a similar recovery time, fewer complications, and a better cosmetic appearance. The aim of this study was to analyze the results of a five-year follow-up of patience who underwent a endoscopic calcaneoplasty for the treatment of haglund`s disease. Methods: This is a prospective case series describing 11 patients who underwent endoscopic calcaneoplasty for the resection of Haglund's deformity at a tertiary hospital in Belo Horizonte, Brazil, between 2016 and 2020. All patients underwent weight-bearing radiographs that confirmed the presence of Haglund's deformity, refractory to conservative treatment for more than 6 months, including activity modification, non-steroidal anti-inflammatory drugs, shoes modifications and physical therapy. All the patients underwent a eightbearing radiographic that confirmed the presence of haglund deformity and MRI that evidenced of inflammation at the retrocalcaneal bursa. Only one patient had a small intratendinous calcification. None of these patients had severe intratendinous disease. Exclusion criteria included previous infection, ipsilateral surgery on the insertional Achilles tendon, and corticosteroid injection within 6 months before surgery. All patients signed the informed consent form (ICF). Results: A total of 13 surgeries were performed on 11 patients: 7 unilateral surgeries and 2 bilateral surgeries, with 6 men and 5 women. The average age of the patients was 48.7 years, and the average BMI was 25.6. The preoperative VISA-A score was an average of 37 points. After 1 year, the average was 87 points. After 5 years, the average score was 85 points. For the SF-12 (PCS) score, the preoperative average was 34.60 points. After 1 year, the average was 53.52 points. As for the SF-12 score (MCS), the initial average was 42.42 points. After 1 year, the average score was 55.32 points. One patient experienced a recurrence of symptoms during follow-up. Conclusion: Endoscopic calcaneoplasty is a safe and effective procedure for the treatment of insertional Achilles tendinopathy without intratendinous lesions. With the advancement of minimally invasive surgery, endoscopic calcaneoplasty has proven to be as effective as open surgery, with a lower complication rate, less painful and faster rehabilitation process.