Diamondback Double-Row Reconstruction with Proximal Modification for the Treatment of Chronic Insertional Achilles Tendinosis

Chronic insertional Achilles tendinosis is a common source of posterior heel pain. When nonoperative treatment fails, surgical procedures include debridement of unhealthy tissue, enthesophytes, and Haglund’s deformity. This surgical procedure often entails detaching the Achilles tendon from its insertion, followed by a reconstructive procedure to re-attach the Achilles tendon to the bone. Most common double-row repairs involve 2 proximal and 2 distal anchors with crossing sutures. This technique may have several limitations, including the proximal portion of the tendon not being compressed to bone and the lack of complete coverage of the distal Achilles insertion. This paper describes a new double-row technique to address these potential shortcomings, aiming for a more biomechanically favorable repair with a quicker functional recovery. The method and 1-year outcomes from a series of 33 patients are described. Level of Evidence: Level IV.