RESUMEN
INTRODUCTION: The Zadek Osteotomy has been described as an effective technique for the treatment of insertional Achilles tendinopathy. Recently, this strategy has been modified using minimally invasive techniques. A learning curve has been observed in many minimally invasive procedures in foot and ankle surgery. This retrospective study first intended to evaluate if there is a learning curve associated with the percutaneous Zadek Osteotomy. Further, if a learning curve was observed, we planned to assess the data for associated changes in complications and postoperative outcomes. METHODS: A retrospective analysis of 98 patients who underwent percutaneous Zadek Osteotomy was performed. Patient charts were reviewed for operative times, complications, union rates, and Foot Function Index (FFI) and Visual Analogue Scale (VAS) scores. Analysis of variance was utilized to assess for differences between groups of cases. RESULTS: Patients included 61 females and 37 males. Mean age was 51.28 ± 11.12 (range 28-81) years. Mean follow-up time was 42.07 ± 12.99 (range 24-65) months. Significant increases in operative times were observed in cases 1-14 when compared to cases 15-98 (p < 0.001). Improvements in FFI and VAS scores were observed at final follow-up within each case group (p < 0.001); there were no differences detected in FFI or VAS scores between groups of cases. There was no difference detected in number of complications between intervals of cases. CONCLUSION: A learning curve was observed for the percutaneous Zadek Osteotomy, which was overcome around case 14. This learning curve was only observed in terms of procedure length. A surgeon's level of inexperience with the technique does not appear to affect functional outcomes, nonunion, or need for revision. LEVEL OF EVIDENCE IV: Data will not be deposited in a repository.
RESUMEN
Background: Bone marrow aspirate (BMA) is used with the putative goal of enhancing healing of injured tissue. The most common sites to harvest BMA are the iliac crest, the tibia, and the calcaneus. Investigators have found that the tibia and calcaneus have fewer progenitor cells than the iliac crest. This retrospective review evaluates the efficacy and safety profile of harvesting BMA from the calcaneus bone. We hypothesized that harvesting BMA from the calcaneus will have high efficacy and safety profile with low complication rates. Methods: A retrospective chart review of patients undergoing bone marrow aspiration from the calcaneus bone from January 2019 to October 2022 was performed. The main data points evaluated were patient satisfaction and pain level, follow-up times, quantity of BMA harvested, fusion rates, and complications including nerve damage, infections, and nonunions. Results: There were 45 (34 female and 11 male) patients who underwent 45 procedures. The average age, BMI, and amount of BMA were 45.1 years (range 23-79), 33.1 (range 19.2-61.3), and 10.3 mL (range 2-40), respectively. There was no pain reported at the final follow-up in 32 patients (71.1%), and there was minimal to no pain in the area of surgery in the remaining 13 patients (28.9%). The 10 cases of fusion successfully healed with combined use of allograft and BMA. The average follow-up time was 12.3 months (range 2.4-33.7). There were no infections, wound complications, or nerve injuries. Conclusion: Harvesting BMA from the calcaneus bone is a safe procedure. In this heterogenous series where BMA augmented other surgical strategies, patients had little to no pain and there were no cases of wound complication or iatrogenic neuropraxia after undergoing bone marrow harvest from the calcaneus. Level of Evidence: Level IV, case series.
