Comparison of endoscopic and open Achilles SpeedBridge techniques in the treatment of insertional Achilles tendinopathy: A prospective multicenter study of 89 patients by the Francophone Arthroscopy Society.

Abstract

Introduction: Insertional Achilles tendinopathy (IAT) is common, affecting 2% of the general population and up to 10% of runners. Despite this, medical and surgical treatments remain debated. When medical treatment fails, a procedure including open debridement, decompression, and reinsertion of the Achilles tendon is the recommended technique. However, this approach involves risks such as infection, shoe discomfort, or failure. In this context, endoscopic techniques have been developed. The primary objective of our study was to compare the outcomes of open and endoscopic surgical treatments for IAT. Our hypothesis was that endoscopic surgery would allow faster recovery (resumption of walking and sports activities) than would open surgery.

Methods: A prospective multicenter study was conducted at 10 French centers specializing in foot and ankle surgery from May 2021 to May 2023. Patients over 18 years of age with IATs resistant to medical treatment for more than 6 months and who underwent decompression/reinsertion surgery were included. Two groups were formed based on surgical approach: open or endoscopic. Demographic data were collected, and functional evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using the EFAS (European Foot & Ankle Society) and VISA-A (Victorian Institute of Sport Assessment - Achilles tendinopathy questionnaire) scores. Postoperative complications were assessed at 1 month.

Results: Of the 89 patients included, 53 (59.5%) underwent endoscopic surgery, and 36 (40.5%) underwent open surgery. The two groups were comparable preoperatively, except for higher functional scores in the endoscopic group. At 3 months, the VISA-A (p < 0.001), EFAS daily life (p < 0.001), and EFAS sports activity (p < 0.022) scores were significantly better in the endoscopic group. At longer follow-up, all functional scores improved in both groups, with no statistically significant difference. Shoe discomfort at 6 months was reported in 2/53 (3.7%) endoscopic patients and 5/36 (13.8%) open surgery patients (p = 0.099).

Conclusion: Our prospective study reported good functional outcomes for IAT surgery. Endoscopic surgery appeared to allow faster recovery and less shoe discomfort.

Level of evidence: III.