Saraiva Daniel, Knupp Markus, Freitas Daniel, Rodrigues André Sá, Pato Tiago, Tulha José, Gomes Tiago Mota, Oliva Xavier Martín
Department of Orthopedics, Hospital da Prelada, Porto, Portugal.
Mein Fusszentrum, Basel, Switzerland.
Foot Ankle Orthop. 2025 Jun 26;10(2):24730114251348194. doi: 10.1177/24730114251348194. eCollection 2025 Apr.
Gastrocnemius tightness has been implicated in the pathogenesis of calcified insertional Achilles tendinopathy (IAT), Haglund deformity, and Achilles intratendinous calcifications (IC). The aims of this study were to determine long-term clinical and radiographic results of combined proximal medial gastrocnemius release (PMGR) and Achilles tendon debridement and reattachment (ATDR) for patients presenting with symptomatic calcified IAT.
A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of PMGR and ATDR for patients presenting with symptomatic calcified IAT, at a minimum follow-up of 30 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P) and the Foot and Ankle Outcome Score (FAOS). Radiographic evaluation included Fowler-Phillip angle, calcification length, calcification width, and presence of Achilles IC, measured on standard weightbearing lateral calibrated radiograph of the foot preoperatively and last available follow-up evaluation for each patient.
The mean follow-up was 46 (range, 30-72) months. We registered 45 "very satisfied" patients (84.91%), 6 "satisfied" patients (11.32%), and 2 "unsatisfied" patients (3.77%), as well as statistically significant improvement on both clinical scores tested. We found statistically significant differences between the initial evaluation and last available follow-up on all radiographic measurements. There was no significant radiographic recurrence of calcified IAT, whereas minor Achilles intratendinous calcifications were found in 10 patients (18.87%).
Combined PMGR and ATDR provides significant clinical and radiographic improvement for patients presenting with symptomatic calcified IAT and, although not preventing radiographic recurrence of minor Achilles IC, may reduce the rate of radiographic recurrence of calcified IAT, though the lack of a control group limits causal inference.
Level III, retrospective cohort study.
腓肠肌紧张与钙化性跟腱附着点病（IAT）、Haglund畸形和跟腱内钙化（IC）的发病机制有关。本研究的目的是确定联合近端内侧腓肠肌松解术（PMGR）和跟腱清创及重新附着术（ATDR）治疗有症状的钙化性IAT患者的长期临床和影像学结果。
进行一项回顾性队列研究，以确定PMGR和ATDR治疗有症状的钙化性IAT患者的临床和影像学结果，最短随访30个月。在最后一次可用随访时评估患者满意度，分为非常满意、满意和不满意。进行临床评估，评估术前和最后一次可用随访时的疼痛视觉模拟量表（VAS-P）和足踝结果评分（FAOS）。影像学评估包括Fowler-Phillip角、钙化长度、钙化宽度以及跟腱IC的存在情况，在术前和每位患者最后一次可用随访评估时，在标准负重足部外侧校准X线片上进行测量。
平均随访时间为46（范围30 - 72）个月。我们记录了45例“非常满意”的患者（84.91%）、6例“满意”的患者（11.32%）和2例“不满意”的患者（3.77%），并且所测试的两项临床评分均有统计学意义的改善。我们发现所有影像学测量在初始评估和最后一次可用随访之间存在统计学意义的差异。钙化性IAT没有明显的影像学复发，而10例患者（18.87%）发现有轻微的跟腱内钙化。
联合PMGR和ATDR为有症状的钙化性IAT患者提供了显著的临床和影像学改善，尽管不能预防轻微跟腱IC的影像学复发，但可能降低钙化性IAT的影像学复发率，不过由于缺乏对照组限制了因果推断。
III级，回顾性队列研究。
