Studies of
minimally invasive surgery for insertional Achilles
tendinopathy are limited. To establish this surgery, the following techniques must be minimally invasive:
Exostosis resection at the Achilles tendon insertion,
debridement of degenerated Achilles tendon, reattachment using anchors or augmentation using flexor hallucis longus (FHL)
tendon transfer, and excision of the posterosuperior calcaneal prominence. Studies on these four perspectives were reviewed to establish
minimally invasive surgery for insertional Achilles
tendinopathy. Techniques for
exostosis resection were demonstrated in one case study, where blunt dissection around the
exostosis was performed, and the
exostosis was resected using an abrasion burr under fluoroscopic guidance. Techniques for
debridement of degenerated Achilles tendon were demonstrated in the same case study, where the space left after resection of the
exostosis was used as an endoscopic working space, and the degenerated Achilles tendon and intra-tendinous calcification were debrided endoscopically. Achilles tendon reattachment techniques using
suture anchors have been demonstrated in several studies. However, there are no studies on FHL
tendon transfer techniques for Achilles tendon reattachment. In contrast, endoscopic posterosuperior calcaneal prominence resection is already established. Additionally, studies on ultrasound-guided surgeries and percutaneous dorsal wedge calcaneal
osteotomy as
minimally invasive surgery were reviewed.