DOI: 10.1177/24730114261469545 ISSN: 2473-0114

Arthroscopic vs Percutaneous Minimally Invasive Debridement and Reinsertion for the Treatment of Insertional Achilles Tendinosis: A Retrospective Analysis of Patient-Reported Outcomes

Sofia Rivera, Jorge I. Acevedo, Eric H. Durudogan, Kevin D. Martin, Anish R. Kadakia
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Background:

Minimally invasive surgery (MIS) for insertional Achilles tendinopathy (IAT) has been adopted to reduce soft tissue trauma, accelerate recovery, and minimize complications associated with open procedures. Both percutaneous and arthroscopic repairs have demonstrated favorable outcomes, but direct comparison is limited. This study compares complication rates and patient-reported outcomes (PROs) between the two techniques. We hypothesized that both approaches would achieve postoperative scores comparable to population means.

Methods:

This retrospective nonrandomized cohort study included patients undergoing percutaneous or arthroscopic IAT repair with minimum 1-year follow-up. PROs including Foot and Ankle Ability Measure Activities of Daily Living subscale (FAAM ADL), Patient-Reported Outcomes Measurement Information System for Physical Function (PROMIS PF), and visual analog scale (VAS) scores were analyzed using Bonferroni adjusted significance thresholds (α = 0.05/3 = 0.0167). Minimal clinically important difference (MCID) achievement was compared using χ 2 tests and sensitivity analyses were performed to account for baseline differences (α = 0.05).

Results:

Fifty patients (25 arthroscopic, 25 percutaneous) were included. The arthroscopic group had significantly longer follow-up ( P  < .001), and a significantly higher prevalence of diabetes ( P  < .01). There were no complications. All PROs improved significantly from baseline ( P  < .001 or P  < .01). Postoperative VAS scores were significantly lower in the percutaneous group (0.3 ± 0.5 vs 1.6 ± 1.7, P  < .01), averaging 2.2 points lower after adjustment (β = −2.22, 95% CI −3.33 to −1.12; P  < .001). Postoperative FAAM ADL scores were higher in the percutaneous group (92.4 ± 15.5 vs 82.5 ± 15.5), although this did not meet the pre-specified significance threshold ( P  = .03; α = 0.0167); after adjustment, scores averaged 13 points higher in the percutaneous group (β = 12.99, 95% CI 1.29-24.69, P  < .05).

Conclusion:

Both percutaneous and arthroscopic MIS approaches were associated with significant improvements in pain and function postoperatively. The percutaneous approach was associated with significantly lower postoperative pain scores after adjustment, and may also be associated with higher FAAM ADL scores, although this finding did not meet the pre-specified significance threshold and requires confirmation in larger prospective studies.

Level of Evidence:

Level III, retrospective comparative study.

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