Purpose

Posterior lumbar fusion using minimally invasive surgical (MIS) techniques are reported to minimise postoperative pain, soft tissue damage and length of hospital stay when compared to the traditional open procedure.

The Achilles tendon is commonly operated on, but has associated wound complications, ranging from 7–14% in previously reported series larger than 100 cases. We report a retrospective review of one surgeon’s practice conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon. The study evaluated the incidence of infection, and other wound complications such as suture reactions, scar revision, hematoma, incisional neuromas and granuloma formation.

A total of 219 surgical cases were available for review (140 males, 70 females; average age at the time of surgery: 46.5 ± 12.6 years, range 16–75). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, with an overall complication rate of 22 of 219 surgeries (10.1%). There were no hematomas. Seven patients had additional surgery following their wound complications; some had simple granuloma excision, while one necessitated a flap. Patients with risk factors such as diabetes, smoking and Rheumatoid arthritis necessitating steroids were more likely to have a wound complication, (Fisher’s Exact Test, P=.03).

Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed fashion. Absorbable and non-absorbable suture can be implicated.

Context: Published data on extracorporeal shock wave therapy (ESWT) for heel pain provide controversial evidence about the clinical effectiveness. In previous studies, three interventions of ESWT without local anaesthesia demonstrated excellent outcome.

Objective: To give confirmatory proof of effectiveness and safety of focused ESWT administered without local anaesthesia in the treatment of chronic painful heel syndrome.

Design and Participants: Prospective, double-blind, randomized, placebo-controlled multicenter FDA trial conducted among 250 patients.

Interventions: ESWT (0.25 mJ/mm²) or placebo. Both groups received three interventions of 2000 shock wave impulses, each session 1 week apart.

Main Outcome Measures: The primary outcome was the percentage change of heel pain quantified by VAS composite score, as well as the change of Roles and Maudsley score at 12 weeks after the last intervention compared to baseline. Secondary endpoints were defined as single success rates (more than 60% reduction of morning pain, pain at daily activities, and pain with force-meter), overall success rate, physician’s judgment of effectiveness; patient’s satisfaction with outcome, patient’s willingness to recommend treatment, and subject’s analgesic medication consumption.

Results: Follow-up was excellent with 246 patients (98.4%) available for intention-to-treat analysis at 12-week follow-up. ESWT resulted in a 69.2% reduction of heel pain regarding the primary endpoint VAS composite score compared to baseline, compared to 34.5% for placebo (p=0.0027, one-sided). ESWT was also significantly superior to placebo for the Roles and Maudsley score (p=0.0006, one-sided). The combined overall result of the eight secondary criteria also showed statistical significance (P = 0.0015 one-sided, multivariate directional Wilcoxon-Mann-Whitney test). No clinically relevant device-related adverse events were recorded.

Conclusion: The results of the present study provide confirmatory proof of effectiveness of ESWT without local anaesthesia in the treatment of refractory painful heel syndrome.

Background: The Achilles tendon is commonly operated on, but has associated wound complications, ranging from 7–14% in previously reported series larger than 100 cases.

Methods: A retrospective review of one surgeon’s practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon. The study evaluated the incidence of infection, and other wound complications such as suture reactions, scar revision, hematoma, incisional neuromas and granuloma formation.

Results: A total of 219 surgical cases were available for review (140 males, 70 females; average age at the time of surgery: 46.5 ± 12.6 years, range 16–75). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, with an overall complication rate of 22 of 219 surgeries (10.1%). There were no hematomas. Seven patients had additional surgery following their wound complications; some had simple granuloma excision, while one necessitated a flap.

Conclusion: Knowledge of suture materials, proper incision placement and possibly avoiding tourniquet usage can keep complications low when performing Achilles tendon surgery. Regardless, some complications with Achilles tendon surgery may be unavoidable.