Summary

A prospective study to evaluate the new three portal endoscopic calcaneoplasty technique for providing access to the retrocalcaneal space,allowing adequate endoscopic resection of Haglund’s deformity, excision of retrocalcaneal bursa and Achilles tendon debridement

Abstract

Title: A Prospective Study to evaluate the results of Endoscopic Management for Haglund’s Syndrome using 3 portal technique.

Authors: Kumar V, Singh K, Sharma A

ABSTRACT

Introduction

Haglund's syndrome is a constellation of soft tissue and bony abnormalities and represents one of the causes of posterior heel pain. This is a prospective study to evaluate the new three portal endoscopic calcaneoplasty technique for providing access to the retrocalcaneal space,allowing adequate endoscopic resection of Haglund’s deformity, excision of retrocalcaneal bursa and Achilles tendon debridement.

Materials And Methods

Patients of Haglund’s syndrome who had proper trial of conservative treatment for at least 6 months duration and did not get adequate relief and opted for endoscopic surgical treatment were included in the study. Total 18 patients (23 Heels) were studied. The patients were operated under spinal anaesthesia in prone position with tourniquet application around thigh. First a visualizing portal, 5 cm proximal to the insertion and just lateral to Achilles tendon, was established to access the retrocalcaneal space. Next two distal portals- medial and lateral were made under vision at superior aspect of calcaneum adjacent to insertion of Achilles tendon as working portals. The inflamed retrocalcaneal bursa was shaved, posterosuperior calcaneus deformity was resected and degenerated Achilles tendon was debrided. The outcome was assessed by comparing preoperative and postoperative (till 24weeks) clinical scoring using Ogilvie Harris Score, Maryland Foot Score and Ankle and Hindfoot Scale (AOFAS) at 6 weeks, 12 weeks and 24 weeks.

Results

and Observations:Of the total of 23 heels, 2 patients lost in follow up and 21 heels were assessed. According to Ogilvie-Harris score, of the 21 patients 6 (28.5%) had good while 15 (71.4%) showed excellent results at end of 24 weeks. AOFAS score was 56.42 ± 8.60 pre operatively which improved significantly to 91.67 ± 4.40 in postoperative period. Maryland Foot score was 54.17 ± 5.84 preoperatively and was 94.50 ± 3.23 post operatively at end of 24 weeks, the difference was statistically significant. The repeated measured Anova test in postoperative follow-up at 6, 12 and 24 weeks also show significant difference among themselves suggesting continuing improvement in follow-up. No major complications were noted except paraesthesia on medial aspect ankle in 3 patients and portal scar site hyperasthesia in 4 patients

Conclusion

There was statistically significant improvement in patients operated via 3 portal endoscopic technique for Haglund’s syndrome in terms of clinical and functional outcome. Endoscopic management offers good results in patients of Haglund’s syndrome with failed conservative treatment.