Combined Endoscopic SpeedBridge™ Reinsertion and Proximal Medial Gastrocnemius Lengthening for Chronic Insertional Achilles Tendinopathy in an Elite Sprinter: A Case Report.

INTRODUCTION: Insertional Achilles tendinopathy (IAT) is common in running athletes and, when refractory to conservative treatment, may require surgery. Open debridement and reinsertion are associated with wound-healing complications and prolonged recovery, which are particularly problematic in sprinters, whose performance depends heavily on the gastrocnemius-soleus-Achilles complex. Endoscopic double-row (SpeedBridge™) Achilles reinsertion may reduce soft-tissue morbidity, while concomitant gastrocnemius tightness is increasingly recognized in the pathogenesis of IAT. Return to sport after such surgery is rarely documented, and the need to correct an associated high-arched hindfoot remains debated. We report a single-stage combined procedure in an elite sprinter, with deliberate non-correction of a marked pes cavus.

CASE REPORT: A 24-year-old elite international-level female sprinter presented with chronic right IAT that had remained symptomatic for approximately 2 years despite structured conservative treatment and three platelet-rich plasma injections. Clinical examination revealed pes cavus and a positive Silfverskiöld test, consistent with gastrocnemius tightness. Weight-bearing lateral radiography showed a calcaneal pitch of 40°. Magnetic resonance imaging (MRI) confirmed insertional tendinopathy with intratendinous calcification, without significant retrocalcaneal bursitis or bone-marrow edema. A single-stage procedure was performed, combining proximal medial gastrocnemius lengthening with endoscopic calcaneal SpeedBridge™, including calcaneoplasty, debridement of calcifications, central tendon detachment, and knotless double-row reinsertion using 4.75-mm anchors. Immediate full weight-bearing, thromboprophylaxis, and early physiotherapy were prescribed. The Victorian institute of sport assessment-Achilles score was 81 at 6 months, and control MRI at that time was normal. Running was resumed in water and on an anti-gravity treadmill at 4 months, jogging at 6 months, high-intensity track running at 9 months, and starting-block sprinting at 13 months, when the patient was pain-free. The patient returned to official competition and pre-injury level at 16 and 20 months of follow-up, respectively.

CONCLUSION: To the best of our knowledge, this is the first report documenting return to sport after combined endoscopic SpeedBridge™ reinsertion and proximal medial gastrocnemius lengthening for IAT in an elite athlete. This case supports a tendon-and-muscle-chain strategy with minimal soft-tissue morbidity and suggests that bony correction of an associated pes cavus is not mandatory to obtain a good functional outcome in this setting.