CME OnDemand: Small Incisions, Big Results: MIS to the MAX-Symposium 4: Sports

Video Transcription

Video Summary

The symposium focused on minimally invasive surgery (MIS) techniques for managing sports medicine issues of the foot and ankle, particularly insertional Achilles tendinosis, Achilles ruptures, chronic Achilles ruptures, peroneal tendinopathy, and lateral ankle ligament repair. <br /><br />Dr. Anish Kadakia advocated for MIS insertional Achilles repair, highlighting its advantages such as reduced wound complications, faster rehabilitation, and strong fixation using double-row speed bridge constructs with rip-stop techniques. He emphasized that MIS avoids major tendon detachment and maintains calcaneal pitch, making it preferable, especially in flat-footed patients. However, he acknowledged that complications like non-union, though rare and technique-dependent, remain a consideration.<br /><br />Contrastingly, Dr. Oliver Schipper described the MIS Zadik osteotomy, which indirectly decompresses the Achilles insertion by anteriorizing the calcaneus without tendon detachment. This technique improves dorsiflexion and offers low complication rates and good patient-reported outcomes with minimal strength or gait deficits. Schipper noted surgical precision is critical to avoid non-union and plantar fascia complications.<br /><br />For Achilles ruptures, Dr. Nick Strash reviewed percutaneous Achilles repair methods, highlighting their comparable biomechanical strength and fewer wound issues versus open repairs, though sural nerve injury risk remains. He described his surgical technique emphasizing careful suture management and anchor fixation.<br /><br />Dr. Fernando discussed managing chronic Achilles ruptures with endoscopic flexor hallucis longus (FHL) tendon transfer, a safe minimally invasive method yielding good outcomes and fewer skin complications compared to open repair.<br /><br />Dr. Robbie Ray presented peroneal tendoscopy and groove deepening to address peroneal tendon pathologies and instability minimally invasively, with promising preliminary results primarily in conjunction with lateral ligament surgery.<br /><br />Lastly, Dr. Daniel Bomfield introduced all-inside arthroscopic lateral ligament repair, a minimally invasive anatomical technique addressing micro- and macro-instability with internal brace adjuncts, allowing rapid rehabilitation and good outcomes.<br /><br />Panel discussions highlighted evolving MIS approaches that aim to reduce complications, hasten recovery, and maintain function. Experts agreed that both MIS insertional Achilles repairs and Zadik osteotomy are effective, with choice depending on surgeon skill and patient factors. MIS Achilles repair for acute ruptures is increasingly used in athletes. Advanced age is no longer a contraindication to surgical repair with MIS techniques. Overall, the session underscored a paradigm shift toward minimally invasive foot and ankle surgery in sports medicine.

Asset Subtitle

Moderator: Eric I. Ferkel, MD

Insertional Achilles: Let's Focus on the Tendon
Anish R. Kadakia, MD

Insertional Achilles: Let's Leave the Tendon Alone
Oliver N. Schipper, MD

Achilles Ruptures: Suture Repair versus Anchor Into the Heel
Nicholas L. Strasser, MD

Achilles Ruptures: If It's Chronic, Do an Endoscopic Transfer
Fernando Raduan, MD

Peroneal Tendoscopy & Endoscopic Fibular Groove Deepening
Robbie Ray, MBChB, ChM(Tr&Orth)

All Inside Ankle Lateral Ligament Repair/Reconstruction
Daniel Baumfeld, MD

Questions/Case Discussion

Keywords

minimally invasive surgery

MIS

sports medicine

foot and ankle

insertional Achilles tendinosis

Achilles ruptures

peroneal tendinopathy

lateral ankle ligament repair

Zadik osteotomy

percutaneous Achilles repair

endoscopic flexor hallucis longus tendon transfer

peroneal tendoscopy

all-inside arthroscopic lateral ligament repair