Reinsertion Achilles Tendon VS Zadek Osteotomy in Insertional Achilles Tendinopathy

Assiut University

Status: Not yet enrolling

Conditions: Insertional Achilles Tendinopathy

Treatments: Procedure: Zadek osteotomy; Procedure: Reinsertion achilles tendon

Study type: Interventional

Funder types: Other

Identifiers

NCT06322381

Reinsertion AT VS ZO in IAT

Details and patient eligibility

About

The aim of this study is to Compare functional outcome and the recovery time of reinsertion of achilles tendon VS zadek osteotomy in insertional achilles tendinopathy.

Full description

Insertional Achilles tendinopathy is characterized by chronic posterior heel pain associated with posterosuperior calcaneal exostosis or intratendinous ossification. The etiologies include retrocalcaneal exostosis, the diseased tendon, enthesopathy, and Haglund's deformity. The nonsurgical therapies, such as physical therapy, stretching and strengthening of the gastrocnemius-soleus muscle complexes, nonsteroid anti-inflammatory drugs, and footwear modifications, are chosen as the initial treatment. Local injection of the steroid is not recommended because it might lead to increase risk of tendon rupture.

Surgical intervention is a suitable option when conservative treatment for more than 6 months has failed. Open detachment with reattachment of the Achilles tendon is a common surgery combined with calcaneoplasty and debridement of the retrocalcaneal bursitis and pathologic Achilles tendon. Suture techniques using bone anchors have been described to reattach the Achilles tendon with excellent results. percutaneous Osteotomy is another option, first described by Zadek in 1939 which was later modified in 1965. zadek osteotomy is a dorsal closing wedge calcaneal osteotomy that allows the tuberosity of Haglund deformity to be brought forward. This operation can change the calcaneus' anatomical length and elevate the distal insertion point of the AT. The rationale of a ZO was to reduce the impingement between the anterior aspect of the Achilles tendon and the superior angle of the posterior calcaneal tuberosity. By shortening the calcaneus and altering the orientation of the Achilles tendon fibers it is believed to decrease stress across the tendon at its insertion.

Enrollment: 42 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age range 18 - 65
• Insertional Achilles tendinopathy without steroid injection, infection, tendon rupture and ankle fracture

Exclusion criteria

• Age < 18 years, > 65
• General medical contraindications to surgical interventions
• Calcaneal Fracture, subtalar fusion
• infection.
• Pathological tendon rupture
• History of steroid injection

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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42 participants in 2 patient groups

Reinsertion achilles tendon

Active Comparator group

Description:

Reinsertion Achilles tendon by 2-4 anchors.

Treatment:

Procedure: Reinsertion achilles tendon

Zadek osteotomy

Active Comparator group

Description:

A calcaneal osteotomy was then performed, two Kirschner wires, were then inserted from the posterior aspect of the calcaneus, over which cannulated screws were used for fixation of the osteotomy.

Treatment:

Procedure: Zadek osteotomy