성인에서의 병적 위치 변형이 없는 아킬레스건 종골 후방 부착부의 특징: 자기공명영상 계측 연구 = Characteristics of Achilles Tendon Insertion on Posterior Aspect of the Calcaneus without Pathological Deformity in Adults: A Magnetic Resonance Imaging Study

다국어 초록 (Multilingual Abstract)

Purpose: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. Materials and Methods: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. Results: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group ($1.47{\pm}0.25cm$) than in the middle insertion group ($1.27{\pm}0.35cm$). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). Conclusion: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

참고문헌 (Reference)

1 Kim PJ, "Variability of insertion of the achilles tendon on the calcaneus : an MRI study of younger subjects" 50 : 41-43, 2011

2 Lohrer H, "The achilles tendon insertion is crescent-shaped : an in vitro anatomic investigation" 466 : 2230-2237, 2008

3 Jones DC, "Partial calcaneal osteotomy for retrocalcaneal bursitis" 12 : 72-73, 1984

4 Frey C., "Master techniques in orthopaedic surgery: the foot and ankle" Lippincott Williams and Wilkins 357-367, 2002

5 Marieb EN, "Human anatomy" Benjamin Cummings 285-287, 1992

6 안수한, "Haglund씨 병에서 시행한 내시경적 감압술의 결과" 대한족부족관절학회 12 (12): 197-202, 2008

7 Standring S., "Gray's anatomy: the anatomical basis of clinical practice" Elsevier Churchill Livingstone 1536-, 2005

8 van Dijk CN, "Endoscopic calcaneoplasty" 29 : 185-189, 2001

9 Ortmann FW, "Endoscopic bony and soft-tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis" 28 : 149-153, 2007

10 Irwin TA, "Current concepts review : insertional Achilles tendinopathy" 31 : 933-939, 2010

11 Rohen JW, "Color atlas of anatomy" Williams & Wilkins 462-463, 1998

12 Hamilton WG, "Clinical symposia: surgical anatomy of the foot and ankle" Ciba-Geigy 1-32, 1985

13 Chao W, "Achilles tendon insertion : an in vitro anatomic study" 18 : 81-84, 1997