PMC9792762_01
Preoperative mediolateral (A) and craniocaudal (B) radiographs of the affected right calcaneal region. Note soft tissue swelling in the cauda-ventral aspect of the calcaneal tuber of the right tarsal joint, in absence of bone lesion. (arrow). Postoperative mediolateral (C) and craniocaudal (D) radiographs. Temporary restraining pin placed on the lateral aspect of calcaneal tuber (C,D, dotted arrow). A 2.4 x 8.5 mm biocomposite suture anchor (SutureTak; Arthrex Inc. Naples, FL) placed on medial aspect of calcaneal tuber (C, arrow head).
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F1
Radiographs revealed soft tissue swelling in the cauda-ventral aspect of the calcaneal tuber, in absence of bone lesion (Figure 1). Postoperative radiographs were taken immediately to confirm the position of the temporary restraining k-wire (Figure 1).
Intraoperative photographs of a flattened groove of calcaneal tuber [(A), arrowhead]. Note the deepened depth of the calcaneal tuber following calcaneoplasty [(B), arrow]. Medial retinaculum was repaired using 2.4 x 8.5 mm biocomposite suture anchor (SutureTak; Arthrex Inc. Naples, FL) and 2-0 non-absorbable braided suture (FiberWire; Arthrex Inc. Naples, FL) [(C), dotted arrow]. Temporary restraining pin was placed on the lateral aspect of calcaneal tuber.
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F2
The medial bursa was incised, and the SDFT was retracted laterally with a Hohmann retractor to expose the calcaneal tuber (Figures 2, 3). A flattened and smooth surface of the calcaneal tuber was identified on gross observation (Figure 2A). A block recession calcaneoplasty was performed (length x width x depth: 8.5 x 4 x 3 mm) in order to deepen the groove (Figures 2B, 3B). The bed of the block was deepened to 3 mm until the SDFT glided smoothly without impingement (Figure 2B). Naples, FL) (Figures 2C, 3C,D).
A schematic diagram of block recession calcaneoplasty (A,B). The bone flap was made by using a hobby saw and mini lambotte osteotome (B). Deepening of the calcaneal tuber was performed using a high-speed burr and the bone flap was replaced on the cancellous bone bed. The retinaculum was repaired using a 2.4 x 8.5 mm biocomposite suture anchor (SutureTak; Arthrex Inc. Naples, FL) and 2-0 non-absorbable braided suture (Fiberwire; Arthrex Inc. Naples, FL) in simple continuous pattern (C,D). A temporary restraining pin was placed on the lateral aspect of calcaneal tuber to prevent reluxation of SDFT tendon.
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F3
The medial bursa was incised, and the SDFT was retracted laterally with a Hohmann retractor to expose the calcaneal tuber (Figures 2, 3). A block recession calcaneoplasty was performed (length x width x depth: 8.5 x 4 x 3 mm) in order to deepen the groove (Figures 2B, 3B). Naples, FL) (Figures 2C, 3C,D). The restraining pin was bent medially for covering SDFT to prevent lateral luxation (Figure 3D).
Postoperative computed tomography of the calcaneal tuber (A,B). The calcaneal groove depth was measured from the level of medial and lateral calcaneal tuber to the calcaneal groove. The depth of the unaffected left calcaneal tuber (A) was 2 mm, and that of the right was 3 mm postoperatively (B). Caudocranial view of the three-dimensional reconstruction of the bilateral calcaneal tuber [(C): left, (D): right]. Note that the right calcaneal tuber groove is deepened compared with the left side.
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F4
Computed tomography (CT) was performed 7 weeks postoperatively after removing the temporary restraining k-wire, confirming that the groove depth of the right calcaneal tuber was deeper than the unaffected contralateral groove (right, 3 mm; left, 2 mm) (Figure 4).