Systematic Review With Video Illustration
Surgical Treatment of Chronic Retrocalcaneal Bursitis

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Purpose

The purpose of this systematic review was to analyze the results of surgical treatments for chronic retrocalcaneal bursitis (RB).

Methods

Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, and the Cochrane Library (1945 to December 2010) were systematically searched for the following terms: calcaneal AND (prominence OR exostosis) OR ((retrocalcaneal OR calcan*) AND (burs* OR exosto* OR prominence)) OR Haglund[tw] OR Haglund's[tw] OR ((retrocalcaneal OR calcan*) AND (ostectom* OR osteotom* OR resect*)). Therapeutic studies on 10 or more subjects with RB were eligible. Quality was assessed by use of the GRADE scale and Downs and Black scale.

Results

Of 876 reviewed abstracts, 15 trials met our inclusion criteria evaluating 547 procedures in 461 patients. Twelve trials reported an open surgical technique; three studies evaluated endoscopic techniques. Differences in patient satisfaction favored the endoscopic technique. The complication rate differed substantially, favoring endoscopic surgery over open surgery.

Conclusions

There are many different surgical techniques to treat RB. Regardless of technique, resecting sufficient bone is essential for a good outcome. Even though the level of evidence of included studies is relatively low, it can be concluded that endoscopic surgery is superior to open intervention for RB. More evidence is a necessity to be more conclusive regarding the best surgical treatment.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

Section snippets

Methods

A systematic review of the literature was performed. The databases of Medline, EMBASE (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1947 to January 2011) were searched by use of the following terms: calcaneal AND (prominence OR exostosis) OR ((retrocalcaneal OR calcan*) AND (burs* OR exosto* OR prominence)) OR Haglund[tw] OR Haglund's[tw] OR ((retrocalcaneal OR calcan*) AND (osteotom* OR resect*)). In addition, the Cochrane Database of Clinical and Randomized

Results

After the results were combined and duplicates were removed, the search retrieved 876 articles. On the basis of the title, abstract, and study design, 797 articles were excluded (Fig 1). We selected 79 articles for full-text evaluation; however, the full text of 16 articles could not be retrieved. A review of the references of the full-text articles resulted in 8 new articles. Thus a total of 71 full-text articles were reviewed. We excluded 48 articles based on the full text (no outcome data or

Discussion

To our knowledge, this is the first systematic review to evaluate surgical treatment for chronic RB. Previous studies have focused on insertional problems of the Achilles tendon. One evaluated study did include patients with chronic RB50; the remaining articles, however, did not. This study evaluated 15 studies on the surgical treatment of chronic RB. A total of 547 procedures in 461 patients were evaluated; 12 trials reported on an open surgical technique, whereas 3 studies evaluated

Conclusions

There are many different surgical techniques to treat RB. Regardless of technique, a sufficient resection of bone is essential for a good outcome. Even though the level of evidence of included studies is relatively low, it can be concluded that endoscopic surgery is superior to open intervention for RB. More evidence and a clear description of the treated pathology are a necessity to be more conclusive regarding the best surgical treatment.

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      However, the open procedures are associated with high rate of complications including Achilles tendon avulsion, persistent posterior heel pain, wound breakdown, scar tenderness, altered heel sensation, nerve injuries (sural nerve), incisional neuroma, and ankle stiffness.10,30,39,59 Recent development of endoscopic and minimally invasive approaches will have fewer complications and better outcome.56,60–63 It is thought that endoscopic approach may not be possible to entirely remove the posterior calcaneal step spur or all diseased tissue in patients with full-thickness intratendinous calcifications, and it may be a more appropriate treatment for patients with disease characterized primarily by enlargement of the posterior superior calcaneal tuberosity.56

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

    Note: To access the video illustrations accompanying this report, visit the February issue of Arthroscopy at www.arthroscopyjournal.org.

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    Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.