Boden Stephanie A, Boden Allison L, Mignemi Danielle, Bariteau Jason T
Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.
Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia.
Foot Ankle Spec. 2018 Apr;11(2):162-167. doi: 10.1177/1938640017740676. Epub 2017 Nov 14.
Insertional Achilles tendinopathy (IAT) is a frequent cause of posterior heel pain and is often associated with Haglund's deformity. Surgical correction for refractory cases of IAT has been well studied; however, the method of tendon fixation to bone in these procedures remains controversial, and to date, no standard technique has been identified for tendon fixation in these surgeries. Often, after Haglund's resection, there is large exposed cancellous surface for Achilles reattachment, which may require unique fixation to optimize outcomes. Previous studies have consistently demonstrated improved patient outcomes after Achilles tendon reconstruction with early rehabilitation with protected weight bearing, evidencing the need for a strong and stable anchoring of the Achilles tendon that allows early weight bearing without tendon morbidity. In this report, we highlight the design, biomechanics, and surgical technique of Achilles tendon reconstruction with Haglund's deformity using a novel technique that utilizes ultrasonic energy to liquefy the suture anchor, allowing it to incorporate into surrounding bone. Biomechanical studies have demonstrated superior strength of the suture anchor utilizing this novel technique as compared with prior techniques. However, future research is needed to ensure that outcomes of this technique are favorable when compared with outcomes using traditional suture anchoring methods.
Level V: Operative technique.
插入性跟腱病（IAT）是足跟后部疼痛的常见原因，且常与Haglund畸形相关。IAT难治性病例的手术矫正已得到充分研究；然而，这些手术中肌腱与骨的固定方法仍存在争议，迄今为止，尚未确定这些手术中肌腱固定的标准技术。通常，在Haglund切除术后，跟腱重新附着处有大面积暴露的松质骨表面，这可能需要独特的固定方法来优化手术效果。先前的研究一致表明，跟腱重建术后早期进行保护性负重康复，患者预后得到改善，这证明需要对跟腱进行牢固稳定的锚定，以便早期负重且不发生肌腱病变。在本报告中，我们重点介绍了采用一种新技术进行伴有Haglund畸形的跟腱重建的设计、生物力学和手术技术，该技术利用超声能量使缝合锚液化，使其融入周围骨组织。生物力学研究表明，与先前技术相比，采用这种新技术的缝合锚具有更高的强度。然而，与使用传统缝合锚定方法的结果相比，需要进一步的研究来确保该技术的效果良好。
V级：手术技术。
