Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy
Figure 3
Case 1, a 67-year-old male complained of right posterior heel pain for 1 year. He could not perform the heel-rise test preoperatively and also showed uric acid level of 462 mmol/L in blood. (a) Preoperative radiograph showed calcification in the Achilles tendon insertion. (b) Postoperative radiograph demonstrated that calcaneal calcification had been removed. (c) Central tendon-splitting approach through longitudinal incision was used to partially elevate the tendon. (d) The tendinosis portion was thoroughly debrided, and the exostosis was removed by rongeur forceps and oscillating saw. (e) After the exostosis were completely resected, the posterior calcaneal wall was levelled off. (f) The inner anchors were inserted in the proximal calcaneal tuberosity. (g) The outer anchors were inserted in the distal calcaneal tuberosity and formed the double row suture bridge. (h) Continuous suture was used to repair the split tendon.