Rousseau R, Gerometta A, Fogerty S, Rolland E, Catonné Y, Khiami F
Service de chirurgie orthopédique et traumatologie, Hôpital de la Pitié-Salpêtrière, 47-83 Boulevard de l'hôpital, 75013, Paris, France.
Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2494-501. doi: 10.1007/s00167-014-2986-5. Epub 2014 Apr 19.
Calcaneus insertional tendinopathy in runners is common and involves important therapeutic controversies. The object of this study was to determine the delay and level of return to sport after insertional surgery in runners, with and without tendon damage.
Eighteen runners underwent surgery for insertional calcaneus tendinopathy. Nine required an exostosectomy/bursectomy, and nine others required a tendon reinsertion/autograft. All patients were clinically assessed pre- and post-operatively with AOFAS scores and post-operatively with ATRS. This series included analysis of "pure conflicts" and "severe insertional lesion" scores. If the insertional tendon was free or the lesion was smaller than 50 %, the group was classified as "pure conflict/minor tendon damage". In the situation in which a loss of tendon occurred or the tendon lesion was greater than 50 %, the group was classified as "major tendon damage". Pre-operatively, the AOFAS "overall", "pure conflicts/minor tendon damage" and "major tendon damage" groups' scores were 58.5 ± 15, 68.2 ± 8.8 and 48.9 ± 13.9/100, respectively.
Post-operatively, the AOFAS "overall", "pure conflicts/minor tendon" and "major tendon damage" groups' scores were 93.7 ± 8.2, 93.2 ± 10.2 and 95.2 ± 5.7/100, respectively. The AOFAS score gain for each group was, respectively, 35.2 ± 19, 24 ± 17 and 46.3 ± 14.1. The ATRS "overall", "pure conflicts/minor tendon damage" and "major tendon damage" groups' scores were 81.5 ± 14.9, 78.3 ± 20.1 and 84.7 ± 6.7/100, respectively. The global sport recovery delay was 9.3 ± 4.1 months; it was 6 ± 3.3 months for the pure conflict/minor tendon damage subgroup and 10 ± 4.6 months for the severe tendon damages subgroup.
Achilles insertional tendinopathy surgery on this population results in few complications with good functional results if the surgical technique is adapted to the type of tendon injury. The clinical relevance of this study is that it highlights the various forms of calcaneus insertional tendinopathy and various treatment options. The authors show that in the case of major tendon damage, time to return to sport is longer.
跑步者跟腱止点性肌腱病很常见，且存在重要的治疗争议。本研究的目的是确定跑步者在进行止点手术（伴或不伴肌腱损伤）后恢复运动的延迟时间和恢复水平。
18名跑步者接受了跟腱止点性肌腱病手术。9名需要进行骨赘切除术/滑囊切除术，另外9名需要进行肌腱重新植入/自体移植。所有患者在术前和术后均采用美国足踝外科协会（AOFAS）评分进行临床评估，术后采用跟腱康复评分系统（ATRS）评估。本系列研究包括对“单纯冲突”和“严重止点病变”评分的分析。如果止点处肌腱完整或病变小于50%，则该组被归类为“单纯冲突/轻微肌腱损伤”。如果出现肌腱缺失或肌腱病变大于50%，则该组被归类为“严重肌腱损伤”。术前，AOFAS“总体”、“单纯冲突/轻微肌腱损伤”和“严重肌腱损伤”组的评分分别为58.5±15、68.2±8.8和48.9±13.9/100。
术后，AOFAS“总体”、“单纯冲突/轻微肌腱损伤”和“严重肌腱损伤”组的评分分别为93.7±8.2、93.2±10.2和95.2±5.7/100。每组AOFAS评分的增加分别为35.2±19、24±17和46.3±14.1。ATRS“总体”、“单纯冲突/轻微肌腱损伤”和“严重肌腱损伤”组的评分分别为81.5±14.9、78.3±20.1和84.7±6.7/100。总体运动恢复延迟时间为9.3±4.1个月；单纯冲突/轻微肌腱损伤亚组为6±3.3个月，严重肌腱损伤亚组为10±4.6个月。
如果手术技术适合肌腱损伤类型，对该人群进行跟腱止点性肌腱病手术并发症少，功能效果良好。本研究的临床意义在于它突出了跟腱止点性肌腱病的各种形式和各种治疗选择。作者表明，在严重肌腱损伤的情况下，恢复运动的时间更长。
