Achilles Tendon Rupture

Achilles Tendon Rupture

Anatomy Achilles tendon formed by the Gastrocnemius and Soleus musculature Strongest and thickest tendon in the human bodyCommonly torn 2 to 6 cm proximal to insertionCommonly tornCommon MOI:Pushing off weight bearing foot with knee extendedSudden DF of ankleForceful DF of PF foot

Maquirriain J. Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation. The Yale Journal of Biology and Medicine 2011;84(3):289-300.

Jzsa L, Kvist M, Blint BJ, et al: The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med. ,1989;17: 338 343.

Role of ImagingDiagnosis/assessmentStaging and severity of the injuryEvaluation of integrity after surgery or conservative treatment Illustrates tendon thickening and intrasubstance imaging uniformityIntegrity of structuresTendon, surrounding soft tissue, bony structures

Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54.

. Gold Standard?No true gold standard for diagnosis via imagingSystematic reviews fail to identify recommendation of consistent use of MRI, ultrasound, or radiograph+ Thompson test gold standard for physical evaluation (Sensitivity=.96; Specificity=.93)More research is needed

The diagnosis and treatment of acute achilles tendon rupture. Rosemont, IL: American Academy of Orthopedic Surgeons; 2009.

Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 1998;26(2):266-270.

MRITheoretically best option for determining ruptureUse T1 and T2 combinedConfirmation:Complete disruption of tendon fibers in full tearThickened tendon in partial tears (normal=6 mm A/P)+ Arners sign+ Kagers triangleToygars angle less than 150 degrees

Cetti, R and Anderson, I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Ortho Relat Res. 1993;286:215-221.

Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54.

Ly, J and Bui-Mansfield, L. Anatomy and abnormalities associated with kagers fat pad. American Journal of Roentgenology. 2004;182: 147-154.

T1 T2

UltrasoundBenefitsCost friendlyWidely available equipmentEase of contralateral comparisonAbility to see image during joint motion

FindingsPosterior acoustic shadowingMedian tendon retractionBlood products, herniated fat, debris at site of tendon gap

Hartgerink P, Fessell DP, Jacobson JA, Van Holsbeeck MT. Full- versus partial-thickness achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiological Society of North America. 2001; 220(2).

Dong Q and Fessell DP. Achilles tendon ultrasound technique. American Journal of Roentgenology. 2009; 193(3): W173

RadiographProvides limited soft tissue information

Lateral radiographs can still provide information on Achillestendon and adjacent structures.

Soft tissue swelling and edema maybe present on a plain film radiograph

Abnormalities of Kagers fat pad are common in Achilles tendon ruptures

Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and pathologic conditions of ankle tendons: Current imaging techniques. Radiographics 1992; 12:429444.

Role of Imaging in ManagementUltrasound and MRIs are used following successful intervention to monitor the Achilles tendon.

Abnormalities may show up on images.

Once healed, the torn Achilles tendon will continue to appear thickened and irregular.

Calcifications may also occur at a site of a prior tear.

Post op MRI may show a tendon gap though this tendsto resolve in 12 weeks.

Hollenberg GM, Adams MJ, Weinberg EP. Sonographic appearance of nonoperatively treated Achilles tendon ruptures. Skeletal Radiol 2000; 29:259264.

Fujikawa A, Kyoto Y, Kawaguchi M et-al. Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing. AJR Am J Roentgenol. 2007;189 (5): 1169-74.

Biomechanical and Physical ImpairmentsPain, swelling near the heel and calfPalpable defect at the normal insertion of tendon on calcaneusDecreased/inability to ambulate and full weight bear on affected extremityDecreased plantar flexion strengthIncreased passive dorsiflexion (+ Matles test)Lack of plantar flexion with squeezing of affected calf (+Thompson test)

Stickles SP, Friedman L, Demarest M, Raio C. Achilles tendon rupture. Western Journal of Emergency Medicine. 2015; 16(1): 161-162.

Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 1998;26(2):266-270.

Hess GW. Achilles tendon rupture. Foot Ankle Spec. 2010; 3(1): 29-32http://www.physioadvisor.com.au/assets/256/images/12918256(300x300).jpg

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ReferencesJzsa L, Kvist M, Blint BJ, et al: The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med. ,1989;17: 338 343.Maquirriain J. Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation. The Yale Journal of Biology and Medicine 2011;84(3):289-300.The diagnosis and treatment of acute achilles tendon rupture. Rosemont, IL: American Academy of Orthopedic Surgeons; 2009.Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and pathologic conditions of ankle tendons: Current imaging techniques. Radiographics 1992; 12:429444.Hollenberg GM, Adams MJ, Weinberg EP. Sonographic appearance of nonoperatively treated Achilles tendon ruptures. Skeletal Radiol 2000; 29:259264.Fujikawa A, Kyoto Y, Kawaguchi M et-al. Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing. AJR Am J Roentgenol. 2007;189 (5): 1169-74.Dong Q and Fessell DP. Achilles tendon ultrasound technique. American Journal of Roentgenology. 2009; 193(3): W173Hartgerink P, Fessell DP, Jacobson JA, Van Holsbeeck MT. Full- versus partial-thickness achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiological Society of North America. 2001; 220(2). Stickles SP, Friedman L, Demarest M, Raio C. Achilles tendon rupture. Western Journal of Emergency Medicine. 2015; 16(1): 161-162.Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54. Ly, J and Bui-Mansfield, L. Anatomy and abnormalities associated with kagers fat pad. American Journal of Roentgenology. 2004;182: 147-154.Cetti, R and Anderson, I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Ortho Relat Res. 1993;286:215-221.Hess GW. Achilles tendon rupture. Foot Ankle Spec. 2010; 3(1): 29-32