Achilles tendon-splitting approach and double-row suture anchor repair for Haglund syndrome.

BACKGROUND: Haglund syndrom is characterized as a painful posterosuperior deformity of the heel with possible causes as tight Achilles tendon, high-arched foot and tendency to walk on the outside of the heel. Surgical treatment may be recommended in cases where of insufficient response to nonoperative treatment. This study aims to evaluate the clinical and radiographic results of central Achilles tendon splitting and double-row suture anchor technique in the surgical treatment of patients with Haglund syndrome. METHODS: 27 patients with Haglund syndrome who underwent central Achilles tendon splitting and double-row suture anchor were retrospectively evaluated. The results were evaluated by the pre- and post-operative American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and visual analogue scale (VAS). All patients were evaluated radiographically to assess lateral talus-first metatarsal angle (TMTA), Calcaneal pitch angle (CPA), and the Fowler-Philip angle (FPA) preoperatively and postoperatively. RESULTS: The mean preoperative AOFAS score was 47 ± 7 points; at the end of the follow-up period, it increased to 92 ± 4 points (p < 0.001). The mean preoperative VAS score was 9 ± 0.9 points; at the end of the follow-up period, it was 2 ± 0.6 points (p < 0.001). The lateral TMTA (preoperative: 5° ± 2°; follow-up: 4° ± 2°; p < 0.001), CPA (preoperative: 21° ± 5°; follow-up: 20° ± 5°; p = 0.005) and FPA (preoperative: 55° ± 6°; follow-up: 32° ± 3°; p < 0.001) values decreased at the end of the follow-up period. CONCLUSION: In the absence of an improvement to nonoperative treatment methods, central Achilles tendon-splitting approach appears to be an effective and safe treatment option. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Editorial Commentary: Anatomic or Not, the Tunnel Will Get Wider!

In our experience, arthroscopic tunnel widening is one of the major complications after anterior cruciate ligament (ACL) reconstruction. Even though this complication doesn't require an acute correction or intervention, patients with failed ACL reconstruction along with tunnel widening may need a 2-stage revision in which we have to fill the gap in the tunnels first. Otherwise, this tunnel widening after ACL reconstruction doesn't affect the clinical outcomes of the primary surgery and it won't affect the success of the surgery in the aspects of clinical and functional outcomes.

Acute Carpal Tunnel Syndrome Secondary to Amyloidosis.

INTRODUCTION: ACTS secondary to amyloidosis is a very rare situation in the literature, and here, we present a unique case of ACTS secondary to amyloidosis. CASE REPORT: A 61-year-old male patient was admitted to our hospital with complaints of numbness in the lateral half of his 1, 2, 3, and 4 fingers of his right hand. These complaints started acutely, and the patient did not have a history of trauma. His clinical examination was suitable for acute carpal tunnel syndrome. DISCUSSION: Carpal tunnel syndrome, as well as acute carpal tunnel syndrome, may occur based on different causes. ACTS is very rare, especially when it is not caused by a trauma. Here, we presented a unique case of ACTS based on amyloidosis. CONCLUSION: It should be kept in mind when ACTS may occur in patients with the diagnosis of amyloidosis.