Insertional Achilles Tendinopathy: Surgical Treatment with Double-Row Suture Anchors. Case Series
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Published:
Apr 30, 2025
Keywords:
Insertional Achilles tendinopathy, Haglund deformity, Achilles tendón reattachment, double-row suture anchors, SpeedBridge™
Main Article Content
Abstract
Introduction: Insertional Achilles tendinopathy (IAT) that fails to improve with conservative management often requires surgical intervention. One surgical approach consists of resecting the retrocalcaneal exostosis, debriding intratendinous calcifications, and reattaching the Achilles tendon. The use of a double-row suture anchor system has been proposed to increase the tendon -bone contact area at the insertion site and enhance biomechanical stability. The purpose of this study is to report the clinical and functional outcomes of patients treated with this technique.
Materials and Methods: A retrospective study was conducted on consecutive adult patients who underwent surgical treatment for IAT using a double-row suture anchor system. Demographic data, time to return to work and sports, visual analog scale (VAS) scores, patient satisfaction, and complications were recorded.
Results: Twenty-one patients were included, with a mean age of 55 years (range, 45 -63). Of these, 76.14% reported being very satisfied with the outcome. The average time to return to daily activities was 2.96 months, and the time to return to sports was 5 months. The mean VAS score decreased from 9.26 preoperatively to 2.5 postoperatively (p < 0.05).
Conclusion: Surgical treatment of insertional Achilles tendinopathy with a double-row suture anchor technique is an effective option. It is associated with high patient satisfaction, early return to daily activities, full return to sports, and a low complication rate.
Materials and Methods: A retrospective study was conducted on consecutive adult patients who underwent surgical treatment for IAT using a double-row suture anchor system. Demographic data, time to return to work and sports, visual analog scale (VAS) scores, patient satisfaction, and complications were recorded.
Results: Twenty-one patients were included, with a mean age of 55 years (range, 45 -63). Of these, 76.14% reported being very satisfied with the outcome. The average time to return to daily activities was 2.96 months, and the time to return to sports was 5 months. The mean VAS score decreased from 9.26 preoperatively to 2.5 postoperatively (p < 0.05).
Conclusion: Surgical treatment of insertional Achilles tendinopathy with a double-row suture anchor technique is an effective option. It is associated with high patient satisfaction, early return to daily activities, full return to sports, and a low complication rate.
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How to Cite
Brué, J., Cafruni, V. M., Parise, A. C., Parma, J. M., Villena, D. S., Conti, L. Ángel, Carrasco, N. M., Sotelano, P., & Santini Araujo, M. G. (2025). Insertional Achilles Tendinopathy: Surgical Treatment with Double-Row Suture Anchors. Case Series. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(2), 141-149. https://doi.org/10.15417/issn.1852-7434.2025.90.2.2114
Section
Clinical Research
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References
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tendinopathy. Orthop Traumatol Surg Res 2021;107(6):102854. https://doi.org/10.1016/j.otsr.2021.102854
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injuries of the Achilles tendon. AJR Am J Roentgenol 2000;175(1):251-60. https://doi.org/10.2214/ajr.175.1.1750251
4. Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, et al. Are ultrasound and magnetic resonance
imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med 2003;37(2):149-53. https://doi.org/10.1136/bjsm.37.2.149
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tendinosis: a review of 43 patients. J Foot Ankle Surg 2013;52(5):575-9. https://doi.org/10.1053/j.jfas.2012.11.004
6. Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int 2010;31(10):933-9.
https://doi.org/10.3113/FAI.2010.0933
7. DeOrio MJ, Easley ME. Surgical strategies: insertional achilles tendinopathy. Foot Ankle Int 2008;29(5):542-50.
https://doi.org/10.3113/FAI-2008-0542
8. DeVries JG, Summerhays B, Guehlstorf DW. Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg 2009;48(4):447-51. https://doi.org/10.1053/j.jfas.2009.03.004
9. Sergio F. Haglund’s disease: notes on clinical diagnosis and surgical technique. Foot Ankle Surg 1997;3(4):175-81. https://doi.org/10.1046/j.1460-9584.1997.00071.x
10. Vega MR, Cavolo DJ, Green RM, Cohen RS. Haglund’s deformity. J Am Podiatry Assoc 1984;74(3):129-35.
https://doi.org/10.7547/87507315-74-3-129
11. Witt BL, Hyer CF. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series. J Foot Ankle Surg 2012;51(4):487-93. https://doi.org/10.1053/j.jfas.2012.03.006
12. Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M. Endoscopic Achilles tendon augmentation
with suture anchors after calcaneal exostectomy in Haglund syndrome. Foot Ankle Int 2018;39(5):551-9.
https://doi.org/10.1177/1071100717750888
13. Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, et al. Biomechanical properties of
double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med 2013;41(7):1642-8. https://doi.org/10.1177/0363546513487061
14. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles
tendinosis based on MRI. Foot Ankle Int 2007;28(4):472-7. https://doi.org/10.3113/fai.2007.0472
15. Scott AT, Long CS, Jaramillo TJ, Lara DL, Marois AJ, Juneja P. Review of Achilles tendon reattachment using
double-row knotted and knotless techniques in the management of insertional Achilles tendinopathy. J Foot Ankle Surg 2022;61(5):927-31. https://doi.org/10.1053/j.jfas.2021.12.015
16. Lewis TL, Mason L, Gordon D, Ray R. The Clavien-Dindo complication classification modified for foot and ankle
orthopaedic surgery. Foot Ankle Surg 2022;28(6):800-2. https://doi.org/10.1016/j.fas.2022.03.006
17. Abarquero-Diezhandino A, Vacas-Sánchez E, Hernanz-González Y, Vilá-Rico J. Estudio de los resultados clínicofuncionales de la calcaneoplastia abierta y reparación tendinosa con sistema de cinta y doble hilera en el tratamiento de la tendinopatía insercional del tendón de Aquiles. Rev Esp Cir Ortop Traumatol 2021;65(1):47-53.
https://doi.org/10.1016/j.recot.2020.07.003
18. Stumpner T, Recheis S, Gruber MS, Kindermann H, Mattausch D, Bock P, et al. Achilles tendon debridement,
calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and Athletic performance in patients with insertional Achilles tendinopathy. Foot Ankle Surg 2024;30(8):673-80. https://doi.org/10.1016/j.fas.2024.05.014
19. Calder JDF, Saxby TS. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 2003;24(2):119-21.
https://doi.org/10.1177/107110070302400203
2. Lopes R, Ngbilo C, Padiolleau G, Boniface O. Endoscopic speed bridge: A new treatment for insertional Achilles
tendinopathy. Orthop Traumatol Surg Res 2021;107(6):102854. https://doi.org/10.1016/j.otsr.2021.102854
3. Karjalainen PT, Soila K, Aronen HJ, Pihlajamäki HK, Tynninen O, Paavonen T, et al. MR imaging of overuse
injuries of the Achilles tendon. AJR Am J Roentgenol 2000;175(1):251-60. https://doi.org/10.2214/ajr.175.1.1750251
4. Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, et al. Are ultrasound and magnetic resonance
imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med 2003;37(2):149-53. https://doi.org/10.1136/bjsm.37.2.149
5. Rigby RB, Cottom JM, Vora A. Early weightbearing using Achilles suture bridge technique for insertional Achilles
tendinosis: a review of 43 patients. J Foot Ankle Surg 2013;52(5):575-9. https://doi.org/10.1053/j.jfas.2012.11.004
6. Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int 2010;31(10):933-9.
https://doi.org/10.3113/FAI.2010.0933
7. DeOrio MJ, Easley ME. Surgical strategies: insertional achilles tendinopathy. Foot Ankle Int 2008;29(5):542-50.
https://doi.org/10.3113/FAI-2008-0542
8. DeVries JG, Summerhays B, Guehlstorf DW. Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg 2009;48(4):447-51. https://doi.org/10.1053/j.jfas.2009.03.004
9. Sergio F. Haglund’s disease: notes on clinical diagnosis and surgical technique. Foot Ankle Surg 1997;3(4):175-81. https://doi.org/10.1046/j.1460-9584.1997.00071.x
10. Vega MR, Cavolo DJ, Green RM, Cohen RS. Haglund’s deformity. J Am Podiatry Assoc 1984;74(3):129-35.
https://doi.org/10.7547/87507315-74-3-129
11. Witt BL, Hyer CF. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series. J Foot Ankle Surg 2012;51(4):487-93. https://doi.org/10.1053/j.jfas.2012.03.006
12. Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M. Endoscopic Achilles tendon augmentation
with suture anchors after calcaneal exostectomy in Haglund syndrome. Foot Ankle Int 2018;39(5):551-9.
https://doi.org/10.1177/1071100717750888
13. Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, et al. Biomechanical properties of
double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med 2013;41(7):1642-8. https://doi.org/10.1177/0363546513487061
14. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles
tendinosis based on MRI. Foot Ankle Int 2007;28(4):472-7. https://doi.org/10.3113/fai.2007.0472
15. Scott AT, Long CS, Jaramillo TJ, Lara DL, Marois AJ, Juneja P. Review of Achilles tendon reattachment using
double-row knotted and knotless techniques in the management of insertional Achilles tendinopathy. J Foot Ankle Surg 2022;61(5):927-31. https://doi.org/10.1053/j.jfas.2021.12.015
16. Lewis TL, Mason L, Gordon D, Ray R. The Clavien-Dindo complication classification modified for foot and ankle
orthopaedic surgery. Foot Ankle Surg 2022;28(6):800-2. https://doi.org/10.1016/j.fas.2022.03.006
17. Abarquero-Diezhandino A, Vacas-Sánchez E, Hernanz-González Y, Vilá-Rico J. Estudio de los resultados clínicofuncionales de la calcaneoplastia abierta y reparación tendinosa con sistema de cinta y doble hilera en el tratamiento de la tendinopatía insercional del tendón de Aquiles. Rev Esp Cir Ortop Traumatol 2021;65(1):47-53.
https://doi.org/10.1016/j.recot.2020.07.003
18. Stumpner T, Recheis S, Gruber MS, Kindermann H, Mattausch D, Bock P, et al. Achilles tendon debridement,
calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and Athletic performance in patients with insertional Achilles tendinopathy. Foot Ankle Surg 2024;30(8):673-80. https://doi.org/10.1016/j.fas.2024.05.014
19. Calder JDF, Saxby TS. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 2003;24(2):119-21.
https://doi.org/10.1177/107110070302400203