Minimally invasive surgeries for insertional Achilles tendinopathy: A commentary review

Figure 1 Fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement for insertional achilles tendinopathy[32]. A: Blunt dissection around the exostosis. Two portals were created 1 cm proximal and distal from the exostosis (circles), and blunt dissection around the exostosis was performed using a raspatorium; B: Exostosis resection using an abrasion burr under fluoroscopic guidance (arrowhead). Care was taken not to damage the normal insertion of the achilles tendon (circle). The space left after resection of the exostosis was a working space for endoscopy; C: Endoscopic view from the distal portal. The portion of the achilles tendon that had attached to the exostosis was visible as a free end (T). The unresected exostosis was attached to the tendon (arrowhead). The degenerated Achilles tendon was debrided endoscopically; D: Postoperative fluoroscopic view. The exostosis was totally resected (arrowhead). P: Proximal portal; D: Distal portal; C: The calcaneus; T: Free end.

Figure 2 Pre- and postoperative magnetic resonance imaging of the left calcaneus of a patient with insertional achilles tendinopathy who underwent Fluoroscopic and endoscopic calcaneal exostosis resection and achilles tendon debridement[32]. A: Preoperative magnetic resonance imaging (MRI). Exostosis and intra-tendon ossification were visible (white arrows); B: Postoperative MRI at 9 mo postoperatively. The void space left after resection of the exostosis and intra-tendon ossification was filled with soft tissue providing the same signal as the Achilles tendon, suggesting a natural repair.