Clinical and functional outcomes of the double-row suture anchor technique in the surgical treatment of Haglund syndrome: a prospective observational study

Mrinal Kanti Hazra; Aviroop Chakraborty; Amitava Narayan Mukherjee

doi:10.18203/2320-6012.ijrms20264185

Authors

Mrinal Kanti Hazra 1Department of Orthopaedics, Barasat Government Medical College, Barasat, North 24 Parganas, West Bengal, India
Aviroop Chakraborty Department of Orthopaedics, Barasat Government Medical College, Barasat, North 24 Parganas, West Bengal, India
Amitava Narayan Mukherjee Baguiati Ortho and Joint Replacement Clinic, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264185

Keywords:

Haglund syndrome, Double-row suture anchor, Insertional achilles tendinopathy, Retrocalcaneal bursitis, Central tendon-splitting approach, AOFAS, VISA-A

Abstract

Background: Haglund syndrome comprises a prominent posterosuperior calcaneal tuberosity, retrocalcaneal bursitis and insertional Achilles tendinopathy. Single-row suture anchor repair, with partial tendon detachment, risks incomplete decompression, recurrence and prolonged protected weight-bearing. Double-row fixation permits complete detachment, thorough debridement and stronger footprint repair; evidence in Haglund syndrome is limited.

Methods: Thirty consecutive patients with Haglund syndrome unresponsive to ≥6 months of conservative treatment underwent exostectomy, bursectomy, Achilles debridement and double-row suture anchor reattachment via a central tendon-splitting approach (March 2022–September 2023). AOFAS, hindfoot functional score (HFS), VAS and VISA-A scores were recorded preoperatively and up to 12 months; Arner–Lindholm criteria were applied at final review. Paired t-tests were used (p<0.05).

Results: Mean age was 36.33±6.19 years (60% male); mean follow-up was 29.97±4.99 months. AOFAS improved from 57.47±3.18 to 86.63±5.66 at 12 months, HFS from 51.70±1.66 to 87.53±2.37 and VISA-A from 51.00±3.12 to 87.40±3.50, while VAS fell from 8.13±0.77 to 2.27±0.45 at 6 months (all p<0.001). Arner–Lindholm outcomes were excellent in 14 (46.7%), good in 11 (36.7%) and poor in 5 (16.7%). Recurrence occurred in 5 (16.7%) and residual heel pain in 6 (20%); there were no wound complications, infections or tendon ruptures.

Conclusions: Double-row suture anchor repair via a central tendon-splitting approach produced significant, sustained improvement in pain and function without wound complications or tendon avulsion, allowing earlier mobilisation. Randomised trials against single-row fixation are needed.

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