Technique Tip: Reattachment of the Achilles Tendon after Endoscopic Calcaneoplasty

Endoscopic calcaneoplasty is a minimally invasive technique for resection of inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus.2,4 It is an efficient procedure for retrocalcaneal bursitis, mechanical impingement, or Achilles insertional tendinopathy that fails to respond to conservative treatment.1,2,4 A major contraindication for endoscopic calcaneoplasty is severe calcific insertional Achilles tendinosis2,4 for which extensive detachment of the tendon insertion is required before adequate debridement of the tendon insertion is possible. An open procedure usually is required to achieve secure reattachment of the tendon. The most significant complications after treatment of this condition are incisional wound necrosis and infection. We describe a technique to reattach the Achilles tendon through the endoscopic calcaneoplasty portals to minimize wound complications. McKeon et al.3 demonstrated that increasing the number of sutures is more important than increasing the number of locking loops. By means of a soft-tissue anchor preloaded with two sutures of different colors, eight sutures with Krackow locking stitches can be used through the two portal wounds to reattach the tendon. We reattach the tendon when more than one-third of the tendon insertion is detached. This technique is contraindicated for severe calcific insertional tendinosis because it cannot be adequately debrided by endoscopic means, and an open procedure is required. Moreover, our technique may not provide sufficient strength to repair a complete detachment of the Achilles tendon.