Percutaneous Zadek Osteotomy vs Open Haglund Resection for Insertional Achilles Tendinopathy: Early Outcomes and Complication Rates

Background: Insertional Achilles tendinopathy (IAT) is difficult to manage despite multiple surgical options. Two of the surgical options include an open midline Achilles tendon–splitting Haglund resection and a percutaneous Zadek osteotomy (ZO). The current study compared the patient-reported outcomes and complications of open vs percutaneous procedures in patients with IAT ± Haglund deformity. Methods: A retrospective comparative study of consecutive patients who underwent either an open midline Achilles tendon–splitting Haglund resection or percutaneous ZO for IAT ± Haglund deformity at a single institution with minimum 12 months’ follow-up was performed. Preoperative and postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores and complications were recorded for each patient and compared between cohorts. Results: Forty-three patients were treated with an open midline Achilles tendon–splitting Haglund resection and 34 patients were treated with a percutaneous ZO for IAT ± Haglund deformity. PROMIS function ( P < .001), pain ( P < .001), and mobility ( P < .001) scores significantly improved in patients who received either procedure. In the open midline Achilles tendon–splitting Haglund resection cohort, a significant increase in wound complications (11/43, 25.6%) was observed in comparison to the percutaneous ZO group (1/34, 2.9%; P = .007). Conclusion Both techniques yielded clinically meaningful improvements in PROMIS scores. In this modest retrospective cohort, the percutaneous ZO was associated with fewer minor wound complications; however, this observation should be interpreted cautiously given the limited sample size, short follow-up, and potential selection bias. Level of Evidence: Level III, retrospective cohort study.