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Achillies Tendon Ruptures

The Achilles is the strongest and thickest tendon in the body as well as the most commonly injured tendon. There is a 25% incidence of missed ruptures on initial evaluation, so a high index of suspicion is necessary on the part of the physician. Early surgical repair of the Achilles Tendon Rupture is beneficial. Surgery offers a significantly smaller risk of re-rupture compared to traditional non-operative management as well as faster rehabilitation of the patient.

Background

Achilles tendon ruptures are commonly seen in men in the fourth to fifth decade of life. The Incidence is 7/100,000 in the general population and 12/100,000 in competitive athletes. In 25% of patients there is symptoms of Achilles inflammation prior to the rupture.

Predisposing conditions include:

  • Ochronosis
  • Steroid use
  • Quinolone antibiotics
  • Inflammatory arthritis

Presentation of Acute Ruptures

Usually during Athletic activities with sudden starting or stopping movements.Patients’ will describe the feeling of “being shot or hit in the back of the leg,” .There is immediate pain and an inability to continue their current activity.

Diagnosis

Diagnosis is usually clinical and rarely would you need any supplementary imaging studies.
Findings are:

  • Ecchymosis over the heel suggests tendon rupture
  • Palpable defect may exist between the torn ends of the tendon.
  • Thompson or Simmonds test has been used to detect Achilles tendon ruptures especially acute ruptures.

Thompson_test_acute_ruptures
THOMPSONS TEST FOR ACUTE RUPTURES

Imaging Studies

Imaging studies are rarely indicated for diagnosing an acute Achilles rupture. However, an X-ray may be done if a bony avulsion is suspected. There is no role for an MRI scan in acute ruptures. However, an ultrasound scan of the Achilles may be indicated to see the extent of the tear and essentially helps in surgical planning.

X-ray_bony_avulsion_achillies
X-RAY SHOWING BONY AVULSION OF THE ACHILLES

Treatment Options

Treatment for an acute Achilles rupture is essentially surgical with an effort being made to achieve an end to end repair of the torn tendon ends. This can be achieved by either conventional open surgery or by the newer mini open techniques. The conventional open techniques allows direct visualization of the torn tendon ends but there is a higher incidence of wound complications(infection, wound dehiscence, sinus formation).
The mini-open techniques allow for minimal dissection and consequently there is very small incidence of wound complications.

dresden_technique_acute_ruptures
MINI-OPEN DRESDEN TECHNIQUE FOR ACUTE RUPTURES

achillies_jig_system
THE P.A.R.S ACHILLES JIG SYSTEM