Transition from open surgery to ultrasound-guided minimally invasive surgery for insertional Achilles tendinopathy: similar patient-reported outcomes and substantially lower treatment costs

Background Insertional Achilles tendinopathy is commonly treated surgically when conservative management fails. Traditionally, open central-splitting surgery (OCS) has been the standard approach, but minimally invasive ultrasound-guided techniques have recently been introduced. This study compared patient-reported outcomes and treatment costs following a transition in surgical practice from open central-splitting surgery to ultrasound- and colour Doppler–guided minimally invasive wide-awake local anaesthesia no tourniquet (WALANT) surgery. Methods This retrospective historical cohort study included fifty-two consecutive patients with insertional Achilles tendinopathy. Twenty patients underwent OCS surgery during 2017–2019, followed by thirty-two patients who underwent US-/CD-guided WALANT surgery during 2020–2022. The primary clinical outcome was the SEFAS score at 12 months. Between-group differences in the 12-month SEFAS scores were analysed using multivariable linear regression adjusted for baseline SEFAS score, age, sex, and BMI. Direct medical costs were estimated from the resource use observed across the two treatment pathways. Results The mean SEFAS score improved from 18 at baseline to 40 at 12 months in the US-/CD group and from 23 to 41 in the OCS group. In the adjusted analysis, the mean difference in the 12-month SEFAS was 0.62 points in favour of US-/CD (95% CI, − 3.50 to 4.73). Estimated direct medical costs were $1,432 per patient for US-/CD and $3,343 for OCS, corresponding to an absolute reduction of $1,911 per patient and approximately 50% lower costs with the US-/CD treatment pathway. Conclusions Following a transition in surgical practice, US-/CD-guided surgery was associated with similar 12-month patient-reported outcomes and approximately 50% lower direct medical costs compared with OCS surgery. These findings suggest that minimally invasive US-/CD-guided surgery under local anaesthesia may offer a less resource-intensive alternative for the surgical treatment of insertional Achilles tendinopathy. Clinical trial number Not applicable.