Achilles Tendon Rupture

Definition: Complete or partial split of the Achilles tendon, most commonly at the musculustendinous junction. This rupture occurs less commonly as an avulsion from the posterior calcaneal tuberosity.

Etiology: Usually involves eccentric loading on a dorsiflexed ankle with the knee extended. Ruptures are commonly seen in relation to an atrophied soleus muscle in recreationally active athletes (“weekend warriors”). Consider gout or hyperparathyroid in pure avulsions. Steroid injections and fluoroquinolones can also be etiologic factors.

Incidence: Unknown.

Age: 3rd to 5th decade of life.

Gender: Male preponderance.

Symptoms: Patients experience acute episode of sharp pain behind the heel (described as being kicked or shot in the back of the leg) followed by an area of tender swelling. An area of nodularity may develop in a partial rupture.

Clinical Findings: The Thompson test is positive (squeezing the calf does not cause plantar flexion). A palpable depression is consistent with a complete rupture.

Diagnostic Studies: Ultrasonography is a fast, inexpensive way to determine the defect gap and tendon thickness. It can also be used for dynamic testing. Magnetic resonance imaging is better for detection of incomplete tears and chronic degenerative changes in the tendon, or to monitor healing.

Treatment: Goals of treatment are to restore length and tension of the tendon and ultimately optimize functional strength. This can be achieved both by nonoperative and operative means.

Nonoperative: Ultrasound can be used to observe appropriate tendon apposition with less than 20 degrees of plantar fl exion. Next, splint immobilization is used for 2 weeks, followed by a short leg cast or boot for 6 to 8 weeks. The patient is weaned from the boot with passive range of motion (ROM) exercises progressing to calf resistance exercises at 8 to 10 weeks. Return to running is accomplished at 4 to 6 months. Full plantar flexion power can take 12 months to achieve, but and residual weakness is common.

Operative: Preferred treatment in younger, athletic patients or in those in whom adequate apposition cannot be achieved by closed means. Technique involves exposing tendon stumps and approximating with 2-4 nonabsorbable sutures using the Krachow, Bunnell, or other technique. Postoperatively, passive ROM exercise can begin as early as 3 to 7 days. Again, a short leg cast or boot should be used for 6 to 8 weeks, followed by progressive resistance exercises at 8 to10 weeks with progression to running at 4 to 6 months. A slight advantage in plantar flexion strength has been observed when compared with nonoperative treatment.

Complications: Re-rupture occurs in 0% to 2% of operative treated patients and 8% to 39% of nonoperative treated patients. Wound infection, skin necrosis, and nerve injury are additional complications reported with operative treatment.

Achilles Tendon Rupture 2017-04-28T20:44:00-07:00 Rating: 4.5 Diposkan Oleh: Unknown