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Calcific Insertional Achilles Tendinopathy

Reattachment With Bone Anchors

Nicola Maffulli, MD, MS, PhD, FRCS, (Orth)^,*, Vittorino Testa, MD, Giovanni Capasso, MD and Alessio Sullo, MD^||

From the Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Staffordshire, England, Department of Sports Traumatology, Dynamic Center, Angri, Italy, Department of Orthopaedics and Traumatology, University of Napoli, Napoli, Italy, and ^|| Rehabilitation Unit, Divisione di Lungodegenza, S. Nicola Baronia, Avellino, Italy

^* Address correspondence and reprint requests to Nicola Maffulli, Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire, ST4 7QB, England.

Background: Recalcitrant calcific insertional Achilles tendinopathy is difficult to treat.

Hypothesis: Bursectomy, excision of the distal paratenon, disinsertion of the tendon, removal of the calcific deposit, and reinsertion of the Achilles tendon with bone anchors is safe and effective.

Study Design: Longitudinal study.

Methods: Twenty-one patients (six women) (21 feet) (average age 46.9 ± 6.4 years) with recalcitrant calcific insertional Achilles tendinopathy were treated surgically with removal of the calcific deposit; the Achilles tendon was reinserted with bone anchors.

Results: At an average follow-up of 48.4 months, one patient necessitated a further operation. Eleven patients reported an excellent result, and five a good result. The remaining five patients could not return to their normal levels of sporting activity and kept fit by alternative means. The results of the VISA-A questionnaire were markedly improved in all patients, from an average of 62.4% to 88.1%.

Conclusions: We recommend disinsertion of the Achilles tendon to excise the calcific deposit fully and reinsertion of the Achilles tendon in the calcaneus with suture anchors. No patient experienced a traumatic disinsertion of the reattached tendon. However, five patients were not able to return to their original level of physical activity.

Key Words: calcific insertional Achilles tendinopathy • surgery

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