Clinical and functional outcomes of the double-row suture anchor technique in the surgical treatment of Haglund syndrome: a prospective observational study

Background: Haglund syndrome comprises a prominent posterosuperior calcaneal tuberosity, retrocalcaneal bursitis and insertional Achilles tendinopathy. Single-row suture anchor repair, with partial tendon detachment, risks incomplete decompression, recurrence and prolonged protected weight-bearing. Double-row fixation permits complete detachment, thorough debridement and stronger footprint repair; evidence in Haglund syndrome is limited. Methods: Thirty consecutive patients with Haglund syndrome unresponsive to ≥6 months of conservative treatment underwent exostectomy, bursectomy, Achilles debridement and double-row suture anchor reattachment via a central tendon-splitting approach (March 2022–September 2023). AOFAS, hindfoot functional score (HFS), VAS and VISA-A scores were recorded preoperatively and up to 12 months; Arner–Lindholm criteria were applied at final review. Paired t-tests were used (p<0.05). Results: Mean age was 36.33±6.19 years (60% male); mean follow-up was 29.97±4.99 months. AOFAS improved from 57.47±3.18 to 86.63±5.66 at 12 months, HFS from 51.70±1.66 to 87.53±2.37 and VISA-A from 51.00±3.12 to 87.40±3.50, while VAS fell from 8.13±0.77 to 2.27±0.45 at 6 months (all p<0.001). Arner–Lindholm outcomes were excellent in 14 (46.7%), good in 11 (36.7%) and poor in 5 (16.7%). Recurrence occurred in 5 (16.7%) and residual heel pain in 6 (20%); there were no wound complications, infections or tendon ruptures. Conclusions: Double-row suture anchor repair via a central tendon-splitting approach produced significant, sustained improvement in pain and function without wound complications or tendon avulsion, allowing earlier mobilisation. Randomised trials against single-row fixation are needed.