Open versus endoscopic bone resection of the dorsolateral calcaneal edge: A cadaveric analysis comparing three dimensional CT scans

Abstract

Background: It has been claimed that endoscopic calcaneoplasty offers some advantages over open techniques in the surgical treatment of Haglund's deformity due to reduced postoperative complications like stiffness and pain. Bony over-resection places patients at risk of these complications. The resulting question with regard to the quantitative differences of the extent of the bone removed using these two techniques has not yet been answered. The purpose of the study was to determine the resection volume of calcaneal bone for open and endoscopic surgical techniques. Methods: 16 feet obtained from body donors were operated on in equal parts using either open surgical or endoscopic techniques, with the technique selected on a random basis. High-resolution CT scans were obtained before and after the interventional procedure and analysed to obtain 3-D polygon models. Post-operative models were subtracted from pre-operative models to provide the volume change resulting from the intervention. This was then correlated with the bone mineral density (BMD) of the preparation. Results: The extent of bony resection was greater in open surgical techniques than in endoscopic approaches. The average volume of bone resection was 0.80 (±0.34) cm3 in the endoscopic group and 3.04 (±2.91) cm3 in the group that underwent open surgery. After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery. The two groups did not differ significantly with regard to BMD (p > 0.1). The extent of the resection fell by 0.011 cm3 per 1 mg/cm3 areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density. Conclusions: Assuming that the resection volume was adequate to treat the patient's complaints a smaller resection volume seen in our study using an endoscopic technique might lead to fewer postoperative complaints and faster recovery.