2025 AOFAS Annual Meeting-Paper Session 1A

Video Transcription

Video Summary

This session focused on the evolving surgical treatments for insertional Achilles tendinopathy (IAT), a challenging condition often resistant to conservative care. Dr. Acevedo presented a novel minimally invasive surgery (MIS) technique compared to traditional open repair, demonstrating superior functional outcomes measured by PROMIS and VAS scores, with significantly fewer wound complications. Dr. Chapman discussed percutaneous Zadac osteotomy, a less invasive dorsal closing wedge osteotomy of the calcaneus for IAT, showing significant pain and function improvement with low complication rates over one year, though cautioning against aggressive spur removal. Dr. Ventresca evaluated postoperative strength after open Haglund’s resection and Zadac osteotomy, finding minimal strength loss (~1-2%) with both procedures, supporting their efficacy. Dr. Workman analyzed heterotopic ossification (HO) occurrence postoperatively, finding HO was more frequent after endoscopic versus open procedures but did not correlate with pain, suggesting no routine prophylaxis is needed. Dr. Correa shared a prospective five-year case series of endoscopic calcaneoplasty for Haglund syndrome, revealing sustained pain relief, function preservation, and high patient satisfaction with low complication rates. Dr. Ahn presented a biomechanical study using cadaver models and optical strain measurement to assess Achilles tendon strain reduction by varying heel lift heights after repair, suggesting 25-40mm lifts effectively reduce tendon tension during rehabilitation.<br /><br />Panel discussions highlighted ongoing uncertainty about the exact pathology treated (tendinopathy, bursitis, bony deformity) and the mechanisms by which procedures like Zadac osteotomy relieve symptoms—likely by biomechanical strain reduction rather than direct spur removal. Debate addressed osteotomy sizing, location, and the future of open versus MIS approaches. Consensus leaned toward MIS techniques becoming preferred due to fewer complications, with open surgery reserved for complex or revision cases. Overall, these studies reflect promising advances in less invasive Achilles surgery aiming to improve outcomes and reduce morbidity in IAT management.

Keywords

insertional Achilles tendinopathy

minimally invasive surgery

Zadac osteotomy

Haglund's resection

heterotopic ossification

endoscopic calcaneoplasty

Achilles tendon strain

heel lift biomechanics

PROMIS scores

postoperative complications