대한족부족관절학회지 (Journal of Korean Foot and Ankle Society)

  • 제25권2호
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  • Pages.95-99
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  • 2021
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  • 1738-3757(pISSN)
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  • 2288-8551(eISSN)
대한족부족관절학회 (Korean Foot & Ankle Society)
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아킬레스 건병증의 수술 전략

Surgical Strategies for Achilles Tendinopathy

  • Park, Hyun-Woo (Department of Orthopedic Surgery, Dankook University Hospital)
  • 투고 : 2021.04.26
  • 심사 : 2021.05.25
  • 발행 : 2021.06.15
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초록

The surgical treatment of Achilles tendinopathy can be considered after the failure of conservative treatment, and the surgical methods may be divided into two groups; treatments for insertional and non-insertional tendinopathy. In the case of insertional tendinopathy, debridement including tendon and calcification of the diseased lesion, reattachment of the tendon, and calcaneal ostectomy of the Haglund lesion are the primary treatments. If reattachment is not possible, reconstruction should be performed by other methods such as tendon transfer. As a result of surgery for insertional tendinopathy, there is an improvement in the pain and function after surgery, but there are some patients whose pain does not completely disappear. Some residual pain may persist; therefore, the overall success rate of the surgery can be expected to be 80% to 90%. For the patients of non-insertional tendinopathy, conservative treatment through eccentric exercise is the primary treatment, and most of them have reported good results. In case of failure after various conservative treatments, debridement of the diseased lesion and repair of the remaining tendon would be the primary surgical treatments. If the remaining tendon is not sufficient, reconstruction such as tendon transfer should be considered.

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참고문헌

  1. Clain MR, Baxter DE. Achilles tendinitis. Foot Ankle. 1992;13:482-7. doi: 10.1177/107110079201300810.
  2. Kearney R, Costa ML. Insertional Achilles tendinopathy management: a systematic review. Foot Ankle Int. 2010;31:689-94. doi: 10.3113/FAI.2010.0689.
  3. Barg A, Ludwig T. Surgical strategies for the treatment of insertional Achilles tendinopathy. Foot Ankle Clin. 2019;24:533-59. doi: 10.1016/j.fcl.2019.04.005.
  4. Calder JD, Saxby TS. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int. 2003;24:119-21. doi: 10.1177/107110070302400203.
  5. DeOrio MJ, Easley ME. Surgical strategies: insertional Achilles tendinopathy. Foot Ankle Int. 2008;29:542-50. doi: 10.3113/FAI-2008-0542.
  6. Krishna Sayana M, Maffulli N. Insertional Achilles tendinopathy. Foot Ankle Clin. 2005;10:309-20. doi: 10.1016/j.fcl.2005.01.010.
  7. Hunt KJ, Cohen BE, Davis WH, Anderson RB, Jones CP. Surgical treatment of insertional Achilles tendinopathy with or without flexor hallucis longus tendon transfer: a prospective, randomized study. Foot Ankle Int. 2015;36:998-1005. doi: 10.1177/1071100715586182.
  8. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund's deformity. Foot Ankle Int. 2012;33:487-91. doi: 10.3113/FAI.2012.0487.
  9. Andersson G, Backman LJ, Christensen J, Alfredson H. Nerve distributions in insertional Achilles tendinopathy - a comparison of bone, bursae and tendon. Histol Histopathol. 2017;32:263-70. doi: 10.14670/HH-11-790.
  10. Georgiannos D, Lampridis V, Vasiliadis A, Bisbinas I. Treatment of insertional Achilles pathology with dorsal wedge calcaneal osteotomy in athletes. Foot Ankle Int. 2017;38:381-7. doi: 10.1177/1071100716681139.
  11. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current concepts review update: insertional Achilles tendinopathy. Foot Ankle Int. 2017;38:1160-9. doi: 10.1177/1071100717723127.
  12. Carmont MR, Maffulli N. Management of insertional Achilles tendinopathy through a Cincinnati incision. BMC Musculoskelet Disord. 2007;8:82. doi: 10.1186/1471-2474-8-82.
  13. Jarin I, Backer HC, Vosseller JT. Meta-analysis of noninsertional Achilles tendinopathy. Foot Ankle Int. 2020;41:744-54. doi: 10.1177/1071100720914605.
  14. Lohrer H, David S, Nauck T. Surgical treatment for Achilles tendinopathy - a systematic review. BMC Musculoskelet Disord. 2016;17:207. doi: 10.1186/s12891-016-1061-4.
  15. Duthon VB, Lubbeke A, Duc SR, Stern R, Assal M. Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening. Foot Ankle Int. 2011;32:375-9. doi: 10.3113/FAI.2011.0375.
  16. Bedi HS, Jowett C, Ristanis S, Docking S, Cook J. Plantaris excision and ventral paratendinous scraping for Achilles tendinopathy in an athletic population. Foot Ankle Int. 2016;37:386-93. doi: 10.1177/1071100715619989.
  17. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of non-operative treatment of insertional Achilles tendinosis based on MRI. Foot Ankle Int. 2007;28:472-7. doi: 10.3113/FAI.2007.0472.