Mid- to long-term radiological and functional outcomes after calcaneoplasty with Achilles tendon reinsertion for insertional tendinopathy.

BACKGROUND

Insertional Achilles tendinopathy (IAT) significantly impairs function and quality of life, particularly in young athletes. When conservative treatment fails, surgical options include Zadek osteotomy and calcaneoplasty with tendon reinsertion. Although certain preoperative radiological parameters, such as calcaneal inclination and tuberosity length, may influence functional outcomes, comprehensive studies analyzing their impact on calcaneoplasty results remain limited.

OBJECTIVES

To evaluate the mid- and long-term effectiveness of calcaneoplasty with Achilles tendon reinsertion in patients with refractory IAT and to assess the relationship between preoperative radiological parameters (calcaneal inclination) and postoperative functional outcomes.

METHODS

A retrospective analysis was conducted on 38 patients who underwent calcaneoplasty with reinsertion between 2011 and 2024. Mean follow-up was 22 months (IQR: 71) with a median age of 55years (IQR: 10). Preoperative radiological parameters (Ruch, Fowler-Phillips, CLA, BRINK angles, among others) and functional scales (VAS, AOFAS, EFAS, VISA-A, Tegner) were assessed before and after surgery.

RESULTS

Significant postoperative improvement was observed across all functional scales (P<.001, Wilcoxon signed-rank test). Mean VAS pain scores decreased from 8.75±1.27 to 1.71±2.02, while AOFAS scores increased from 38.36±14.55 to 88.82±11.95. EFAS and VISA-A scores improved by 16.46 and 45.59 points, respectively. Tegner scores showed an increase of 50.48 points in athletic capacity. Two complications (5.26%) were reported: one suture granuloma and one case of lateral plantar nerve neuralgia, both successfully managed conservatively. No significant correlation was found between calcaneal inclination or tuberosity length and postoperative functional outcomes. Strengths of the study include a comprehensive functional assessment and consistent follow-up, while limitations include the retrospective design and use of two reinsertion techniques (single- and double-row), with no significant differences in outcomes.

CONCLUSION

Calcaneoplasty with Achilles tendon reinsertion is effective for refractory insertional Achilles tendinopathy, providing sustained mid- and long-term benefits. Preoperative radiological parameters were not significantly associated with postoperative functional outcomes.