A new method for reattachment of the tendo Achillis following retrocalcaneal exostectomy.

Abstract

Currently there are a number of surgical techniques being utilized to address the entity of symptomatic, recalcitrant retrocalcaneal exostosis. This article presents a mechanical study of a modified surgical approach which has been developed at the Northern Virginia Podiatric Residency Program for the purposes of complete resection of all offending exostosis and calcifications, and maintenance of the anatomic configuration of the Achilles tendon with resultant asymptomatic function and cosmetic healing. The centerpiece of the surgical modification is the way in which the portion of reflected Achilles tendon is reattached to the calcaneus, utilizing soft-tissue anchors in combination with a modified Krackow suture technique. In order to delineate the relative strength of this suture technique, a cadaveric study was performed using six specimens. Each specimen underwent tendon repair with both a modified Krackow technique and a modified vertical mattress coaptation technique for a total of 12 studies. The force required to displace the tendon for distances of 0.5 cm and 1.0 cm was then recorded, and the data were statistically analyzed, with the modified Krackow technique proving to have a significantly better ability to resist distractive forces at both 0.5 cm (p = .01) and at 1.0 cm (p = .02) compared to the vertical mattress coaptation technique.