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. 2025 Mar 12;10(1):24730114251322775.
doi: 10.1177/24730114251322775. eCollection 2025 Jan.

Severity of Achilles Tendinopathy on Preoperative MRI and Short-term Functional Outcomes After Minimally Invasive Zadek Osteotomy

SarahRose Hall  1 , Thomas Lewis  2 , Jonathan R M Kaplan  3 , Oliver N Schipper  4 , Ettore Vulcano  5 , A Holly Johnson  6 , Peter Lam  7 , J Benjamin Jackson 3rd  1   8 , Tyler Gonzalez  1   8
Affiliations

Severity of Achilles Tendinopathy on Preoperative MRI and Short-term Functional Outcomes After Minimally Invasive Zadek Osteotomy

SarahRose Hall et al. Foot Ankle Orthop. .

Abstract

Background: Limited literature is available to guide surgeons on which patients with insertional Achilles tendinopathy (IAT) may be the best candidates for minimally invasive dorsal closing wedge calcaneal Zadek osteotomy (MIS ZO). We hypothesized that the severity of IAT on preoperative magnetic resonance image (MRI) may correlate with post-operative functional outcomes and help guide patient selection for treatment with MIS ZO.

Methods: Patients who underwent MIS ZO for IAT ± Haglund deformity were identified and retrospectively analyzed. IAT severity was graded on preoperative MRI. Patient Reported Outcome Measurement Information System (PROMIS) scores, complications, and revisions were recorded. Continuous data were compared by analysis of variance with Bonferroni post hoc analysis.

Results: Seventeen patients treated with MIS ZO, with follow-up >6 months, and preoperative MRI met our inclusion criteria. PROMIS pain scores significantly improved in patients with IAT grades 1-3, with 5, 5, and 7 patients, respectively, in each subgroup. In this small series we only identified statistically significant improvements in PROMIS function (P = .031), and mobility (P = .009) scores were only observed in patients with grade 2 pathology. Sixteen of 17 patients (94.2%) were very satisfied with their procedure and would undergo it again.

Conclusion: In this pilot study, we did not find preoperative MRI findings to correlate well with patient-reported outcome scores following MIS ZO.

Level of evidence: Level IV, case series.

Keywords: Haglund deformity; MRI; Zadek osteotomy; dorsal closing wedge calcaneal osteotomy; insertional Achilles tendinopathy; minimally invasive; percutaneous.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Thomas Lewis, MBChB(Hons), BSc(Hons), MRCS, MFSTEd, reports disclosures relevant to manuscript as consultant for Vilex. Jonathan R. M. Kaplan, MD, reports disclosures relevant to manuscript as consultant for Artelon, Edge Surgical, Enovis / Novastep, Exactech, Surgical Fusion Technologies, Treace Medical Concepts, Vilex, Surgebright; and royalties for Surgical Fusion Technologies, Treace Medical Concepts, Vilex. Oliver N. Schipper, MD, reports disclosures relevant to manuscript as consultant for Treace Medical Concepts Inc, SFI, Enovis, Exatech; and royalties for Treace Medical Concepts Inc, SFI, Enovis. Ettore Vulcano, MD, reports disclosures relevant to manuscript as consultant for Novastep, Treace, Vilex, Surgebright; royalties for Surgical Fusion Technologies, Treace Medical Concepts, Vilex; and stock options for GLW, Curvebeam. A. Holly Johnson, MD, reports disclosures relevant to manuscript from royalties for Novastep, Treace; stock options for Carbon22, Altior Traima, BICMD. Peter Lam, MBBS(Hons), FRACS, reports disclosures relevant to manuscript as consultant for Enovis. J. Benjamin Jackson III, MD, MBA, reports disclosures relevant to manuscript as consultant for Synthes. Tyler Gonzalez, MD, MBA, reports disclosures relevant to manuscript as consultant for Treace Medical Concepts Inc, Surgical Fusion Technologies, Stryker, Enovis, Exactech, Surgebright; royalties for Surgical Fusion Technologies, Treace Medical Concepts, Vilex. Disclosure forms for all authors are available online.

Figures

Visual Abstract
Visual Abstract
This is a visual representation of the abstract.
Supplemental Figure 1.
Supplemental Figure 1.
Preoperative magnetic resonance image findings, preoperative lateral weightbearing radiograph, postoperative lateral weightbearing radiograph for patients with grade 1, grade 2, and grade 3 insertional Achilles tendinopathy.
See this image and copyright information in PMC

References

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