Comparison of open and endoscopic techniques of isolated calcaneoplasty in the surgical treatment of insertional tendinopathy of the Achilles tendon.

Insertional Achilles tendinopathy (IAT) is primarily caused by mechanical overload. Running and obesity are major risk factors. Medical treatment is limited, and surgery, particularly calcaneoplasty, is sometimes necessary. However, the choice between an endoscopic and open approach remains controversial. This study is based on the hypothesis that endoscopic surgery would allow for better functional recovery with a faster return to sports activity compared to traditional open techniques. Our multicenter prospective study compared the outcomes of endoscopic (Endo) and open (Open) calcaneoplasty in patients with IAT resistant to medical treatment. Clinical outcomes were assessed using the EFAS (daily life and sports) and VISA-AF scores. The radiological criteria studied were the calcaneal slope and the X/Y ratio. An MRI was used to quantify tendon involvement. Of the 85 patients included, 51 underwent endoscopic surgery, and 34 had open surgery. The two groups were comparable in terms of demographic, clinical, and radiographic characteristics. At 3 months postoperatively, significantly more patients had returned to sports in the Endo group (41.6% vs. 20.6% in the Open group; p = 0.004), and the EFAS sports score showed a significant difference in favor of the Endo group at 6 months postoperatively (9.3 vs. 5.7 / 16; p = 0.008). The results confirm faster recovery after endoscopic surgery, with comparable complication rates between the two approaches. However, long-term, the differences between the two techniques diminish, with similar functional outcomes at 12 months postoperatively. Endoscopic calcaneoplasty is a safe and effective option for the treatment of IAT. However, further studies with longer follow-up are needed to confirm these results and assess recurrence rates. III.

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