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. 2025 Jul 24;12(3):e70374.
doi: 10.1002/jeo2.70374. eCollection 2025 Jul.

Endoscopic versus open surgery for insertional achilles tendinopathy: A systematic review and meta-analysis of comparative outcomes

Po-Yuan Chen  1 , I-Shiang Tzeng  2 , Kai-Chiang Yang  1   3 , Chen-Chie Wang  1   4
Affiliations

Endoscopic versus open surgery for insertional achilles tendinopathy: A systematic review and meta-analysis of comparative outcomes

Po-Yuan Chen et al. J Exp Orthop. .

Abstract

Purpose: Insertional Achilles tendinopathy (IAT) causes chronic hindfoot pain and functional impairment. Although conservative treatment remains the first-line management approach, surgery is often necessary when nonoperative measures fail. Both open and endoscopic techniques are commonly used, but their comparative efficacy remains debated. Accordingly, this meta-analysis compared surgical outcomes, complications and recovery between open and endoscopic techniques; it also conducted a subgroup analysis to assess return to sports in highly active individuals.

Methods: A systematic literature search was conducted in PubMed, the Cochrane Library, Scopus, ScienceDirect, Web of Science and Embase (2003-2024). Studies were included if they reported outcomes for open or endoscopic IAT surgery with ≥20 patients and ≥6 months of follow-up. Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) scores, time to return to sports, complication rates and additional functional outcome measures.

Results: Thirty-nine studies (1559 patients, 1625 procedures) were included. Mean AOFAS scores improved from 56.07 to 89.17 (p < 0.001), with no significant difference between surgical techniques (p = 0.18). However, endoscopic surgery was associated with a lower complication rate and faster recovery, enabling earlier return to daily activities (6.75 ± 2.25 vs. 22.45 ± 4.74 weeks, p < 0.001) and sports (12.63 ± 2.2 vs. 22.13 ± 7.42 weeks, p < 0.001). Among highly active individuals, endoscopic surgery facilitated return to sports within 12-18 months, whereas open surgery required 20-30 months.

Conclusions: Endoscopic surgery demonstrates a low complication rate and expedited recovery, making it a preferable option for patients requiring an early return to activity. More high-quality studies, such as randomized controlled trials and standardized protocols, are needed to improve surgical decisions and treatment strategies for IAT.

Level of evidence: Level IV.

Keywords: Haglund's deformity; Haglund's syndrome; endoscopic; insertional Achilles tendinopathy; retrocalcaneal bursitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Prisma flow diagram for study selection.
Figure 2
Figure 2
Forest plot of change between pre‐OP and post‐OP in open and endoscopic surgical intervention. CI, confidence interval; IV, intravenous; post‐OP, post‐operative; pre‐OP, preoperative; SD, standard deviation.
Figure 3
Figure 3
One‐study‐removed sensitivity analysis for functional improvement in the endoscopic surgery group. CI, confidence interval.
Figure 4
Figure 4
One‐study removed the sensitivity analysis for functional improvement in the open surgery group. CI, confidence interval.
Figure 5
Figure 5
Mean time (weeks) return to daily life post‐operatively after open and endoscopic surgery.
Figure 6
Figure 6
Mean time (weeks) return to sport post‐operatively after open and endoscopic surgery.
See this image and copyright information in PMC

References

    1. Aldahshan W, Elsherief F, Elbehairy HF, Abdelaziz AM. Endoscopic calcaneoplasty for treatment of Haglund's syndrome. Egypt Orthop J. 2017;53(2):107–112.
    1. Alessio‐Mazzola M, Russo A, Capello AG, Lovisolo S, Repetto I, Formica M, et al. Endoscopic calcaneoplasty for the treatment of Haglund's deformity provides better clinical functional outcomes, lower complication rate, and shorter recovery time compared to open procedures: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2462–2484. - PubMed
    1. Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41(4):211–216. - PMC - PubMed
    1. Allam MT, Fadel ME, Quolquela MA, Samy AM. Surgical resection of Haglund's deformity by Achilles tendon splitting approach. Med J Cairo Univ. 2019;87:3451–3458.
    1. Anderson JA, Suero E, O'Loughlin PF, Kennedy JG. Surgery for retrocalcaneal bursitis: a tendon‐splitting versus a lateral approach. Clin Orthop Relat Res. 2008;466(7):1678–1682. - PMC - PubMed

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