Long-Term Outcomes by Graft Utilization in Insertional Achilles Tendinitis Surgery

Joydeep Baidya, Nana Amponsah, Kush Mody, Amy Nghe, David Pedowitz, Joseph Daniel, Selene Parekh

Introduction: Insertional Achilles tendinitis (IAT) is commonly treated with tendon grafting or occasionally biologics to further reinforce the repair and prevent re-rupture. Common grafts are the plantaris and flexor hallucis tendon transfer. With the increase of recreational sports and activities, more patients are eager to get back into their physical activities after surgery and want to weigh the options that get them recovering faster and stronger. Considering a graft is costly and the long-term results still need to be studied. This study aims to evaluate the long-term outcomes associated with grafting versus no grafting in patients undergoing treatment for IAT. Method: A retrospective analysis was conducted on a cohort of 753 patients, divided into two groups: those who received a graft (n=196) and those who did not (n=557). Ipsilateral retear rates, revision surgery rates, readmission rates, and functional recovery as measured by the Foot and Ankle Ability Measure Visual Analog Scale (FAAM-VAS) scores were analysed. Data was analysed for statistical significance. Results: The analysis revealed a significantly higher rate of ipsilateral retears in the graft group (2.06%) compared to the no graft group (0.18%) (p=0.018), indicating a notable risk associated with grafting. The rate of revision surgeries was slightly higher in the graft group (3.61%) compared to the no graft group (2.01%), although this difference was not statistically significant (p=0.274). Readmission rates were similar between the two groups (7.22% for graft vs. 6.02% for no graft). Functional recovery, assessed via Delta FAAM VAS scores, demonstrated a statistically significantly better improvement in the no graft group (-18.30) compared to the graft group (-1.39) (p=0.033). Conclusion: Our study indicates that long-term results for IAT repair with graft are shown to have a higher rate of retears and revisions and may not be worth the extra cost and risk."