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The online version of this article (doi:10.1186/s13047-014-0056-3) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
This paper contains data from an as yet unpublished thesis by the author RM.
KER was involved in conception and design, analysis and interpretation of the data and the revision of the manuscript. RM participated in the conception, data analysis and interpretation of the study. ES participated in the data collection and interpretation of results of the study. IS and MS participated in the study design and performed the statistical analysis. GSM was involved in analysing and drafting the manuscript. UM conceived of the study and oversaw its design, conduct and interpretation. All of the authors were involved with the manuscript development, and read and approved the final manuscript.
It has been claimed that endoscopic calcaneoplasty offers some advantages over open techniques in the surgical treatment of Haglund’s deformity due to reduced postoperative complications like stiffness and pain. Bony over-resection places patients at risk of these complications. The resulting question with regard to the quantitative differences of the extent of the bone removed using these two techniques has not yet been answered. The purpose of the study was to determine the resection volume of calcaneal bone for open and endoscopic surgical techniques.
16 feet obtained from body donors were operated on in equal parts using either open surgical or endoscopic techniques, with the technique selected on a random basis. High-resolution CT scans were obtained before and after the interventional procedure and analysed to obtain 3-D polygon models. Post-operative models were subtracted from pre-operative models to provide the volume change resulting from the intervention. This was then correlated with the bone mineral density (BMD) of the preparation.
The extent of bony resection was greater in open surgical techniques than in endoscopic approaches. The average volume of bone resection was 0.80 (±0.34) cm3 in the endoscopic group and 3.04 (±2.91) cm3 in the group that underwent open surgery. After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery. The two groups did not differ significantly with regard to BMD (p > 0.1). The extent of the resection fell by 0.011 cm3 per 1 mg/cm3 areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density.
Assuming that the resection volume was adequate to treat the patient’s complaints a smaller resection volume seen in our study using an endoscopic technique might lead to fewer postoperative complaints and faster recovery.
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Myerson MS, McGarvey W: Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect. 1999, 48: 211-218. PubMed
Schepsis AA, Jones H, Haas AL: Achilles tendon disorders in athletes. Am J Sports Med. 2002, 30 (2): 287-305. PubMed
Lohrer H, Arentz S: [Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis - a therapeutic challenge]. Sportverletz Sportschaden. 2003, 17 (4): 181-188. 10.1055/s-2003-45406. Die Impingementlaesion der distalen Achillessehne bei Bursitis subachillae und Haglund-Pseudoexostose – eine therapeutische Herausforderung CrossRefPubMed
Nesse E, Finsen V: Poor results after resection for Haglund's heel: analysis of 35 heels in 23 patients after 3 years. Acta Orthop. 1994, 65 (1): 107-109. 10.3109/17453679408993732. CrossRef
Perlman MD: Enlargement of the entire posterior aspect of the calcaneus: treatment with the Keck and Kelly calcaneal osteotomy. J Foot Surg. 1992, 31 (5): 424-433. PubMed
van Dijk CN, van Dyk GE, Scholten PE, Kort NP: Endoscopic calcaneoplasty. Am J Sports Med. 2001, 29 (2): 185-189. PubMed
Leitze Z, Sella EJ, Aversa JM: Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am. 2003, 85-A (8): 1488-1496. PubMed
Singh R, Rohilla R, Siwach RC, Magu NK, Sangwan SS, Sharma A: Diagnostic significance of radiologic measurements in posterior heel pain. Foot (Edinb). 2008, 18 (2): 91-98. 10.1016/j.foot.2008.01.005. CrossRef
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