Surgical treatment of Haglund syndrome by the central tendon-splitting approach combined with preservation of the Achilles insertion and reinforcement with a single suture anchor: a retrospective single-arm case series of 31 patients with mid-to-long

Abstract Background Haglund syndrome is characterized by insertional Achilles tendinopathy, retrocalcaneal bursitis, and a posterosuperior calcaneal prominence. Although the central tendon-splitting approach is a well-established open technique for managing this condition, the optimal suture anchor configuration for reinforcing the Achilles tendon after central-split debridement, particularly when the tendon insertion is preserved, remains uncertain. Methods We retrospectively reviewed 31 consecutive patients (19 women, 12 men; mean age, 53.2 years) with refractory Haglund syndrome who underwent surgery between November 2016 and September 2022. All patients were treated with intratendinous debridement of calcific deposits, retrocalcaneal bursectomy, posterosuperior prominence resection, through a central tendon split, and reinforcement with a single double-loaded 5-mm suture anchor. The Achilles tendon insertion was preserved in every case. Functional outcomes were assessed using the AOFAS Ankle–Hindfoot score, while radiographic correction was evaluated using the Fowler–Philip angle. The mean follow-up was 42 months (range, 15–92 months). Results The mean AOFAS score improved from 57.7 preoperatively to 93.0 at final follow-up (mean improvement, 35.3 points; p < 0.001). The mean Fowler–Philip angle decreased from 73.3° to 54.8° (mean reduction, 18.5°; p < 0.001). Improvement was observed in all 31 patients for both outcome measures. No cases of Achilles tendon avulsion, deep infection, or wound dehiscence occurred. Complications included two superficial wound problems that resolved with local care, one transient heel numbness that resolved within 12 months, and one revision surgery for symptomatic recurrence at 24 months. Conclusions In this retrospective single-arm case series, a central tendon-splitting approach with preservation of the Achilles insertion and reinforcement using a single suture anchor was associated with favourable mid- to long-term functional and radiographic outcomes.