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. 2022 Jul 31;14(7):e27500. doi: 10.7759/cureus.27500

Table 4. Summary of study characteristics and surgical outcomes.

Y – years, M – months, D – days; FWB – Full weight bear; PWB – Partial weight bear; WBAT – Weight bearing as tolerated; AT – Achilles tendon; DVT – Deep vein thrombosis; VAS - visual analogue scale; FFI – Foot function index; AAS – Ankle activity score; SF-36 – Short form-36; VISA-A - Victorian institute of sports assessment – Achilles questionnaire; PROMIS – Patient-reported outcome measure information system

Schneider et al. [14]; van Dijk et al. [8]; Yodlowski et al. [15]; Leitze et al. [4]; Scholten et al. [2]; Jerosch et al. [9]; Ortmann and McBryde [16]; Anderson et al. [17]; Wu et al. [3]; Kondreddi et al. [6]; Kaynak et al. [18]; Natarajan et al. [19]; Jiang et al. [20]; Xia et al. [5]; Yan et al. [21]; Yasin et al. [22]; Ge et al. [23]; Pi et al. [10]; Tourne et al. [7]; Cusumano et al. [24]

  Main Author Surgical Intervention Surgical Details Results
Conservative period before surgery (mean) Type Number of procedures Diagnostic method Positioning Anaesthesia Approach Details Time (min) Post-operative Protocol AOFAS pre-op AOFAS post-op Other Measures Mean return to work   Mean return to sports Complications Revision Surgery
1 Schneider et al. 3y 7m (4w-28y) Open 49 Xray Prone General Lateral Calcaneal ostectomy, AT decompression, bursectomy, - 13 patients FWB post-op, 36 patients PWB with mean of 4w, 10 patients cast for 3-12w - 93.9 (65-100) 34 complete relief of pain, 7 improvement, 1 no change, 7 worsening 7.5w 20.3w 3 extensive hematoma, 1 superficial infection, 1 recurrent bone spur, 1 foreign body reaction to bone wax, 1 painful ossification  3 revision surgeries for complications (reaction to bone wax, recurrent spur and painful ossification)
2 van Dijk et al. >6m Endoscopic 21 Xray Prone, Supine General, Regional 2 portals Bursectomy, calcaneoplasty 48 FWB and ROM post op - - Ogilve Harris: 1 fair 4 good 15 excellent 7w 12w 1 delayed wound healing Nil
3 Yodlowski et al. >6m Open 41 - Prone - Lateral Bursectomy, AT decompression, calcaneal ostectomy, AT debridement - Walker boot with heel lifts and TTWB first 2w, walker boot, ROM and WB after - - Preop pain 4.7 (1.1 SD), post op pain 1.5 (1.3 SD).   14 completely relieved, 17 significantly improved, 4 improved - 6-9m 14 altered sensations at wound, 1 significant incisions site pain, 1 sural nerve paraesthesia, 1 heel paraesthesia, 1 DVT Nil
4 Leitze et al. 18m (6-36m) Open 17 Xray Supine General Medial or lateral Retrocalcaneal decompression, calcaneal resection 56 Splint and NWB 2w, followed by walker boot with heel lifts and WB 58.1 ± 17.6 79.3 ± 19 3 poor outcomes - - 2 superficial infections, 1 delayed wound healing, 2 incisional paraesthesia, 1 heel numbness, 3 incision site tenderness 1 revision surgery (for symptom recurrence)
Endoscopic 33 Supine General 1 or 2 portals Bursectomy, calcaneal resection, AT debridement 44 61.8 ± 12.9 87.5 ± 15 University of Maryland score 86 ± 17, 19 excellent, 5 good, 3 fair, 3 poor   - - 1 superficial infection, 1 mild sural neuropathy, 1 heel numbness, 1 reflex sympathetic dystrophy-like symptom, 2 port site tenderness 1 revision surgery (for symptom recurrence)
5 Scholten et al. >6m Endoscopic 39 Xray Prone General or regional 2 portals Bursectomy, calcaneal resection, - WB and ROM post op - - Ogilve Harris: 24 excellent, 6 good, 4 fair, 2 not improved 5w (10d-6m 11w (6w-6m) 1 heel numbness, 1 delayed wound healing Nil
6 Jerosch et al. >6m Endoscopic 81 Xray, MRI Prone, supine General or spinal 2 portals Bursectomy, calcaneal resection 28 PWB 2w - - Ogilve Harris: 41 excellent, 34 good, 3 fair, 3 poor - - 1 skin inflammation 3 revision surgery (for symptom recurrence
7 Ortmann and McBryde - Endoscopic 32 Xray, MRI Supine General or regional 2 portals Bursectomy, calcaneal resection, AT debridement - NWB and splint 2w, followed by PWB with walker boot 2-3w then normal walking 62 ± 12.7 97 ± 6.1 26 excellent, 3 good, 1 poor - 6-12w 1 Achilles tendon rupture 2 revision surgeries (1 for symptom recurrence, 1 for complication)
8 Anderson et al. - Open (lateral) 35 Xray Prone - Lateral AT debridement, decompression, calcaneal ostectomy - Cast 4w followed by walker boot for 4-6w. ROM start 4w, TTWB 6-8w 54 (10-72) 86 (10-100) Post op SF-36 mental 54 physical 49   1 residual mild-mod pain, 3 severe pains - 6.5 (4-27) 2 superficial wound infection Nil
Open (central) 31 Prone - Midline AT split, decompression, bursectomy, calcaneal ostectomy, AT insertion, repair - 43 (10-67) 81 (10-100) Post op SF-36 mental 54 physical 52   1 residual mild-mod pain - 5.4 (4-21) 2 superficial wound infection, 1 hypertrophic scar, 1 traumatic TA rupture Nil
9 Wu et al. >6m Endoscopic 25 Xray, MRI Prone Spinal 3 portals Bursectomy, calcaneoplasty, AT debridement 34.8 (20-45) ROM, PWB 2w, FWB after 63.3 ± 11.9 86.8 ± 10.1 Ogilve Harris: 15 excellent, 7 good, 1 fair, 2 poor - - 1 wound inflammation Nil
10 Kondreddi et al. >6m Endoscopic 25 Xray, Ultrasound Prone, Semi-prone Spinal 2 portals Bursectomy, calcaneal resection, AT debridement - NWB 2w, FWB after 57.9 ± 6.2 89.1 ± 5.3 University of Maryland score 90.3 ± 5.8, 16 excellent, 6 good, 3 fair - - 1 wound infection, 2 sural nerve neuropathy, 1 DVT Nil
11 Kaynak et al. >6m Endoscopic 30 Xray, MRI Prone General 2 portals Bursectomy, calcaneal resection, 38 (20-90) ROM first day, WBAT third day, FWB 2w after 52.6 (24-75) 98.6 (90-100) - - 3m Nil Nil
12 Natarajan et al. >6m Open 46 Xray - - Lateral Calcaneal ostectomy - - 58 86 (60-90) 8 patients with poor outcomes (4 delayed recovery and 4 recurrence of symptoms) - - 3 superficial wound infection Nil
13 Jiang et al. - Open (Single row) 16 Xray, MRI Prone - Lateral AT detachment, debridement, calcaneal resection, AT single row - NWB and cast in equinus for 6w, FWB and ROM after 56.1 ± 4.1 81.3 ± 6.5 Preop VISA A score 52.6 ± 5.2, post op 84.1 ± 3.9   Arner-Lindholm 7 excellent 7 good 2 bad   2 symptoms recurrence, 5 mild residual symptoms - - Nil Nil
Open (Double row) 16 Prone - Lateral AT detachment, debridement, calcaneal resection, AT double row - 59.2 ± 6.7 91.1 ± 4.2 Preop VISA A score 50.6 ± 3.2, post op 90.6 ± 3.4   Arner-Lindholm 11 excellent 5 good - 6m Nil Nil
14 Xia et al. >6m Open 22 Xray, Ultrasound, MRI Prone General Midline AT split, partial detachment, debridement, bursectomy, calcaneal resection, AT reattachment 43.4 ± 7.8 Cast with foot in plantigrade 2w, followed by WBAT with walker boot for 4w 39.3 ± 19.5 83 ± 20.7 Preop VAS 7.8 ± 2.0, Post op VAS 1.8 ± 2.7   Pre op SF-36 mental 48.6 physical 36.1   Post op SF-36 Mental 51.1 physical 49.7 - - 2 delayed wound healing, 1 heel numbness, -
15 Yan et al. >3-6m Open (suture anchor) 10 Xray, MRI Supine Spinal Lateral Bursectomy, AT debridement, decompression, calcaneal osteotomy, AT insertion with 2 bone anchors 47.1 (38-56) Cast post op 4w, followed by ankle brace. WB allowed from 6w 47.2 86.3 Pre op VAS 7.6, post op 1.0   Lindholm 7 excellent 3 good - - Nil Nil
Open (allogenic graft) 10 Supine Spinal Medial Bursectomy, AT debridement, graft augmentation and AT insertion 59.5 (49-69) 49.4 81.9 Pre op VAS 7.7, post op 1.6   Lindholm 5 excellent 5 good - - Nil Nil
16 Yasin et al. >3m Open 27 Xray Prone Regional Midline AT central split, bursectomy, AT debridement, calcaneal resection, AT insertion and repair - Brace 10 degrees plantar flexion and PWB (50%) 4w, change to brace in neutral, and allow WB next. After 6w remove brace and ROM 47 ± 7 92 ± 4 Pre op VAS 9, post op 2   - - 3 superficial wound infection Nil
17 Ge et al. >6m Open (dorsal closing wedge osteotomy) 12 Xray Lateral Spinal Lateral Calcaneal closing wedge osteotomy, calcaneal fixation with 2 partially threaded cannulated screws - NWB 4w, passive ROM, PWB with case 6w to 3m, FWB after 52 ± 5.3 98.2 ± 2.3 Preop VISA A score 37.1 ± 5.7, post op 98.2 ± 2.6   - - 1 delayed union of calcaneus Nil
Open (posterosuperior prominence resection) 32 Lateral Spinal Lateral Calcaneal resection - NWB 3w, active ROM. PWB after 3w, FWB after 6w 50.7 ± 5.1 93.4 ± 6.1 Preop VISA A score 35.7 ± 7.1, post op 94.3 ± 5   - - 1 wound infection Nil
18 Pi et al. >6m Open 20 MRI Prone - Lateral AT Debridement, bursectomy, calcaneoplasty 45 ± 11 Brace post op 2w, change to walker boot, WB and ROM 2-4w, FWB 4-6w - 96.1 ± 5.0 Post op VAS 0.9 ± 1.2 Post op FFI 2.1 ± 2.7 Post op Tegner score 3.2 ± 1.2   Post op AAS 4.1 ± 1.6   Post op SF-36 Mental 96.8 physical 86.5 8-12w 8-12w 2 transient paraesthesia at surgical site Nil
Endoscopic 27 Prone - 2 portals Bursectomy, Calcaneoplasty, AT Debridement 65 ± 11 - 92.1 ± 8.0 Post op VAS 1.5 ± 1.8   Post op FFI 3.7 ± 4.7   Post op Tegner score 3.9 ± 1.9   Post op AAS 5.0 ± 2.5   Post op SF-36 Mental 91.3 physical 87.3 8-12w 8-12w Nil Nil
19 Tourne et al. >6m Open 50 Xray, MRI - General and regional Lateral Bursectomy, calcaneoplasty, subtraction osteotomy, calcaneal fixation with 6-hole plate, 2 compression, 4 locking screws - Cast 2w post op, walker boot after and allow FWB. ROM 6w post op. 50.5 ± 12 88.9 ± 9.9 Preop VISA A score 60.4 ± 10, post op 85.3 ± 15.2   40 excellent, 7 good, 3 fair   Tegner scale – 33 returned to sports equivalent to pre-op levels, 13 increased sporting activity, 4 decreased. - 6w 2 transient paraesthesia, 1 complex regional pain syndrome. 6 patients had removal of metalwork due to pain
20 Cusumano et al. - Open 28 Xray Prone Spinal Medial AT central split, bursectomy, calcaneal resection, AT reattachment and repair 28.3 ± 3.3 Cast 2w post op, followed by splint and ROM. NWB 1m total 65.7 ± 10.1 91.8 ± 9.7 Preop VAS 6.3 ± 1.4, Post op VAS 1.2 ± 1.9   FFI (Pain) Pre – 52.2 ± 13.3 Post – 8.4 ± 17.1   FFI (Disability) Pre - 53.4 ± 11.7 Post – 9.3 ± 17.4   2 recurrences of symptoms - 6-12w 1 AT rupture 2 revision surgery (for symptom recurrence
Endoscopic 26 Prone Regional 2 portals Bursectomy, calcaneoplasty 30 ± 4.7 Progressive WB day after surgery 66.7 ± 7.2 93.7 ± 9.7 Preop VAS 7.6 ± 1.3, Post op VAS 1.3 ± 1.9   FFI (Pain) Pre - 55.9 ± 12.3 post - 9.6 ± 16.5   FFI (Disability) Pre – 48.7 ± 12.9 Post – 7.3 ± 12.8   1 recurrences of symptoms - 6-12w 2 wound infections 1 revision surgery (for symptom recurrence   1 revision surgery for complications (wound revision after infection)