Success Rate of Non-Operative Treatment of Insertional Achilles Tendinopathy

Abstract

Category: Other Introduction/Purpose: Non-operative treatment of Insertional Achilles tendinopathy (IAT) is historically thought to be effective in 50-70% of cases, the success rate of modern non-operative treatment is not well defined in the current literature. The purpose of this study is to define the success rate of modern non-operative treatment of IAT. Methods: A retrospective chart review was performed to identify 133 patients (137 ankles) who received either surgical or non- surgical treatment of IAT at an academic medical center between September 2015 and June 2019. The success rates of various non-operative treatment strategies were recorded in order to determine which, if any, had the highest success rate. Patient factors including demographic factors, comorbidities, modifiable risk factors, patient-reported outcome measures (PROMs), physical exam findings, and radiographic parameters were recorded to determine those that are associated with the failure of conservative management of IAT. Results: The overall success rate of non-operative treatment was 82.5% and the average time from initial diagnosis to surgery was 198.83 (range, 28-486) days. There was no difference in treatment method between those successfully treated conservatively and those who went on to require surgery. At first encounter, patients who later received surgery were significantly more likely to be female (91.7% vs. 66.4%; p=.013) and have higher VAS pain scores (6.54 vs. 5.10; p=.045), lower SF-12 physical scores (25.16 vs. 35.61; p<.001), hypertension (79.2% vs. 52.2%; p=.015), Haglund's Deformity on physical exam (95.7% vs. 71.3%; p=.014), and greater cross-sectional tendon disease involvement on MRI (43.5% vs. 28.0%; p=.001). (Table 1) Conclusion: The success rates of non-operative treatment for IAT may be higher than historical reports, at just over 80%. Several patient factors were shown to be associated with the failure of conservative management of IAT. Orthopaedic surgeons should use this information to provide more accurate patient-specific counseling on the most appropriate treatment strategies for IAT.