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. 2024 Sep;45(9):931-939.
doi: 10.1177/10711007241252803. Epub 2024 Sep 1.

Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy

SarahRose Hall  1 , Oliver N Schipper  2 , Jonathan R M Kaplan  3 , A Holly Johnson  4 , Tyler A Gonzalez  1   5 , Ettore Vulcano  6
Affiliations

Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy

SarahRose Hall et al. Foot Ankle Int. 2024 Sep.

Abstract

Background: Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up.

Methods: One hundred eight cases treated with percutaneous ZO with a minimum 2-year follow-up were retrospectively reviewed. Postoperative complications and patient satisfaction were evaluated. Foot Function Index (FFI) and visual analog scale (VAS) scores were recorded at preoperative and follow-up appointments to measure patients' functional outcomes and pain, respectively.

Results: Mean follow-up was 41.2 months (range, 24-65). Mean age was 51.8 years (range, 28-81). The mean FFI score improved from 56.1 (range, 47-88) to 11.0 (range, 7-59) postoperatively (P < .001). The mean VAS score improved from 7.7 (range, 5-10) to 0.4 (range, 0-7) postoperatively (P < .001). The overall complication rate was 3.8% (n = 4). Of 104 cases, 98.1% of patients said they were satisfied with their procedure (n = 102) when asked if they were satisfied with their ZO and recovery.

Conclusion: We found the percutaneous ZO to be a safe and effective intervention for treatment of IAT. At a minimum of 2-year follow-up, this intervention is associated with minimal complications, improved function, reduced pain, and a high rate of patient satisfaction.

Keywords: Haglund deformity; Zadek osteotomy; insertional Achilles tendinopathy; minimally invasive surgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Oliver N. Schiper, MD reports royalties or licenses and consulting fees from Treasce Medical Concepts, Vilex, Exactech, and Enovis. Jonathan R. M. Kaplan, MD, reports royalties or licenses and consulting fees from Artelon, Edge Surgical, Exactech, Surgebright, and Enovis. A. Holly Johnson, MD, reports royalties or licenses from Novastep and Treace Medical Concepts. Tyler A. Gonzalez, MD, MBA, reports royalties or licenses and consulting fees from Treace Medical Concepts, Surgical Fusion Technologies, Vilex; consulting fees from Stryker, Surgebright, and Enovis. Ettore Vulcano, MD, reports royalties or licenses and consulting fees from Novastep, Vilex, and Treace Medical Concepts. Disclosure forms for all authors are available online.

Figures

Graphical Abstract
Graphical Abstract
This is a visual representation of the abstract.
Figure 1.
Figure 1.
Position of the leg in the lateral position on the mini-C-arm to perform the Zadek osteotomy.
Figure 2.
Figure 2.
(A) Clinical and (B) fluoroscopic visualization of K-wire placement and cut guide for percutaneous Zadek osteotomy as described by Kaplan et al.
Figure 3.
Figure 3.
Schematic drawing of cut technique using quadrants in the (A) sagittal and (B) axial plane as described by Kaplan et al.
Figure 4.
Figure 4.
Final fluoroscopic imaging, demonstrating placement of 2 headless cannulated compression screws, perpendicular to the percutaneous Zadek osteotomy as described by Kaplan et al.
Figure 5.
Figure 5.
Clinical visualization of final closure following Zadek osteotomy.
Figure 6.
Figure 6.
FFI and VAS outcome scores relative to follow-up duration.
See this image and copyright information in PMC

References

    1. Black AT, So E, Combs A, Logan D. The Zadek osteotomy for surgical management of insertional Achilles tendinopathy: a systematic review. Foot Ankle Spec. 2023;16(4):437-445. doi:10.1177/19386400231162411 - DOI - PubMed
    1. Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol. 1991;44(6):561-570. doi:10.1016/0895-4356(91)90220-4 - DOI - PubMed
    1. Carmont MR, Maffulli N. Management of insertional Achilles tendinopathy through a Cincinnati incision. BMC Musculoskelet Disord. 2007;8:82. doi:10.1186/1471-2474-8-82 - DOI - PMC - PubMed
    1. Cengiz B, Karaoglu S. Clinical results of the Keck and Kelly wedge osteotomy approach in Haglund’s deformity: minimum 3-year follow-up. Foot Ankle Surg. 2022;28(2):269-275. doi:10.1016/J.FAS.2021.10.006 - DOI - PubMed
    1. Challoumas D, Zouvani A, Creavin K, et al.. Determining minimal important differences for patient-reported outcome measures in shoulder, lateral elbow, patellar and Achilles tendinopathies using distribution-based methods. BMC Musculoskelet Disord. 2023;24(1):158. doi:10.1186/s12891-023-06261-9 - DOI - PMC - PubMed

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