Achilles tendon rupture associated with injury of the calcaneofibular ligament

A 49-year-old man collided against an infielder when he slid into second base during a recreational baseball game. He was unable to continue in the game due to diffuse pain and swelling of his hindfoot. A rupture of the Achilles tendon was diagnosed incidentally on palpation and observation of a positive Thompson's squeeze test. Subcutaneous hemorrhage at the lateral aspect of the heel and a small bone fragment under the lateral malleolus on an anteroposterior plain radiograph indicated a fracture of the calcaneal wall. At surgery, a complete rupture of the Achilles tendon and an avulsion of the calcaneofibular ligament from the calcaneal wall were seen. Both injuries were surgically repaired, and the patient subsequently did well. The mechanism of injury was thought to be impact hyperdorsiflexion of the ankle with rupture of the Achilles tendon accompanied by an inversion injury. Using a literature search, it was found that this combination of injuries has not been previously reported.     

Achilles tendon rupture associated with ankle fracture

The case of a 40-year-old man who sustained a medial malleolar fracture with extension of the fracture into the tibial plafond is discussed. Before surgery, the physical examination revealed an Achilles tendon rupture. Surgical treatment to repair the bone and tendon injury was performed. Achilles tendon rupture is not an uncommon injury, but it is rarely associated with a fracture. When a fracture is present, the Achilles tendon injury can be overlooked, which may result in a delay of treatment or residual morbidity.     

Achilles tendon rupture with open distal tibia and fibula fracture

The authors present a previously unreported case of an open fracture of the distal tibia and fibula with associated Achilles tendon rupture in a 27-year-old motorcyclist. Management followed established trauma principles of wound exploration, debridement, and stabilization of the fracture with reamed locked intramedullary nailing of the tibia. The injury to the Achilles tendon was not identified until surgical exploration for fixation of the fracture. This required a 2-stage operative approach, involving initial debridement and fracture fixation followed by Achilles tendon repair during the second-look wound review procedure. The authors believe this to be the first reported case of Achilles tendon rupture in association with an open transverse distal tibia fracture. Prior to surgical exploration of the wound, Achilles tendon rupture was not suspected, emphasizing the need for clinical suspicion, thorough examination, and adequate wound exploration at operation for fracture fixation.     

Severe ligamentous injury of the ankle with ruptured tendo Achillis and fractured neck of talus

Severe tendon and ligament rupture of the ankle associated with a fracture of the talus were successfully treated by surgical repair followed by cast immobilization. We suggest that the mechanism of injury was forced dorsiflexion with initial rupture of the Achilles tendon, followed by rupture of the ankle ligaments and fracture of the neck of the talus.     

Achilles tendon rupture. Occurrence with a closed ankle fracture

A 61-year-old man, involved in an automobile accident, sustained a complete Achilles tendon rupture with an ipsilateral, closed slightly displaced medial malleolus ankle fracture. The tendon rupture was not diagnosed before operation but was recognized at the time of open reduction of the ankle. This rare combination of injuries was apparently secondary to hyperdorsiflexion of the foot. The tendon rupture would have been missed had surgical treatment not been required. Unrecognized tendon ruptures associated with closed ankle fractures may be a cause of residual ankle-foot weakness, pain, loss of motion, or a combination thereof.     

Häufig und selten kombiniert ergibt sehr selten Kombinierte Talushalsfraktur und Achillessehnenruptur

BackgroundIn both injuries, an isolated Achilles tendon rupture and a talar neck fracture, the mechanism of injury is supposed to be a forced dorsiflexion of the foot. Yet the combination of these injuries is uncommon. It remains uncertain whether further efforts to diagnose a taler neck fracture in any dorsiflexion foot traumas are made. Nevertheless, the knowledge of the presence of a combination of these injuries could be helpful in the decision making between an operative and a conservative therapy option.Material and MethodsA 44-year old mountain biker suffered a forced dorsiflexion of his left foot after landing a jump. In the clinical examination and radiography a Achilles tendon rupture and a talar neck fracture Hawkins I were diagnosed. Due to the combination of injuries, we decided an operative therapy with screw osteosynthesis and direct tendon repair.ResultThree months post-surgical fixation of the talar neck fracture and repair of the Achilles tendon rupture, the patient had regained full weight bearing function despite a slight reduction of the ROM in dorsiflexion/plantarflexion 10/0/20°.ConclusionConsidering the good outcome in this case we highly recommend an operative procedure. Especially due to the high risk for a secondary dislocation of the talus fracture in case of insufficient immobilization.     

Okkulte Fraktur einer Achillessehnenossifikation ohne begleitende Sehnenruptur

Ossification of the Achilles tendon is the result of a traumatic, hypoxic injury of the tendon. The usually asymptomatic ossification has a clinical importance only in case of a new trauma. We report about a patient with an isolated fracture of the ossification without an accompanying rupture of the Achilles tendon. Because of the radiologically "occult" fracture the diagnosis could only be verified by MRI. With a conservative treatment without resection of the ossification we could reach painless recovery.     

Ossification of a ruptured achilles tendon: a case report in a diabetic patient.

Ossification of the Achilles tendon is a rare condition to be distinguished from the more frequently occurring tendon calcification. Achilles tendon ossification is more common in males and is usually associated with prior surgery or trauma to the tendon. A case history of a ruptured ossified Achilles tendon in an elderly diabetic female is presented. Although Achilles tendon rupture with subsequent ossification and fracture of the ossified Achilles tendon have been reported individually, there is evidence to suggest that this patient may have both ruptured and fractured an ossified Achilles tendon.     

Bilateral spontaneous rupture of Achilles tendons: a case report

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.     

The epidemiology of musculoskeletal tendinous and ligamentous injuries

This study describes the epidemiology of a range of adult musculoskeletal soft tissue injuries. Our institution is the only hospital treating adults with musculoskeletal trauma in a well-defined catchment population of about 535,000. Demographic details over 5 years were recorded prospectively. Eighteen injury types were studied including anterior cruciate ligament (ACL) rupture, acromioclavicular joint (ACJ) injury, Achilles, patellar and quadriceps tendon ruptures, hand tendon injuries and mallet finger. 2794 patients presented with ligamentous or tedinous injuries over 5 years. 74.2% of patients were male, giving an incidence of 166.6/100,000 per year for males and 52.1/100,000 per year for females. The mean age was 36.3 years: 33.1 in males, 43.6 in females. 1040 (37.2%) were knee injuries: 75.6% were male with mean age 32.9, compared with 35.3 in females. 947 cases were hand tendon injuries (33.9%): 72.1% were male, with mean age 34.5 compared with 42.0 in females. Meniscal injury of the knee was the commonest injury with an incidence of 23.8/100,000 per year. Other common injuries were hand extensor tendons (18/100,000 per year), ACJ injury (14.5/100,000 per year), Achilles tendon rupture (11.3/100,000 per year), mallet finger (9.9/100,000 per year) and ACL rupture (8.1/100,000 per year). Achilles, patellar and quadriceps tendon rupture and mallet finger were injuries of middle age; rotator cuff tears and biceps tendon rupture were commoner in the elderly but all other injuries predominated in young patients. All injuries were commoner in males. Most soft tissue injuries follow distribution curves previously described for fracture epidemiology but three new distribution curves are presented for the injuries which predominate in middle age.     

跟腱损伤治疗进展

目的介绍跟睫的解剖、损伤的病因、治疗策略及有关的最新进展。方法查阅国内外近年有关文献，并作综合分析。结果皮质类固醇对肌腱的影响仍存在争议，应用喹诺酮类药物治疗可能和肌腱疾病的发生有关。急性跟腱断裂治疗分为开放手术修复、经皮手术和非手术治疗。结论陈旧性跟腱断裂治疗及跟腱缺损的修复手术方式多种多样。多种生长因子的发现为跟腱损伤的治疗提供了新的途径。     

跟腱愈合相关机制的研究进展

跟腱断裂后常以瘢痕愈合为主,导致运动能力下降、功能障碍。本文从跟腱的基本结构、生物力学、断裂后的病理改变、愈合机制以及相关的临床研究探索5个方面,综合阐述跟腱愈合的全过程,并追踪一系列最新的促进跟腱愈合的干预手段,以其对跟腱愈合的后续研究有所帮助。     

锚钉在跟腱断裂修复中的应用

目的探讨应用强生Fastin锚钉治疗跟腱断裂的临床效果。方法 18例新鲜跟腱断裂患者,断裂平面距止点平均1.5（0-2.5）cm。手术取跟腱内侧纵形切口,暴露跟腱断端,修整后在跟骨结节跟腱止点处置入强生Fastin带线锚钉,用锚钉上连接的Ethibond-2号缝线缝合断裂跟腱。结果 18例均获得随访,平均13（8-15）个月。术后X线片未见骨锚松动或脱落。按Arner-Lindholm标准评定疗效,优14例,良3例,差1例,优良率94.4%。结论 Fastin锚钉治疗止点附近跟腱断裂临床效果满意,具有肌腱修复可靠、操作简单、术后并发症少的优点,具有良好的应用前景。     

The incidence of Achilles tendon ruptures in Edmonton, Canada

BACKGROUND: The incidence of Achilles tendon ruptures specific to the North American population has not been previously reported and current epidemiological data are primarily reported from European communities. The purpose of this study was to determine the incidence of Achilles tendon ruptures in the city of Edmonton, Alberta, Canada, and to compare this data to those reported in European studies. METHODS: A retrospective chart review from all five acute care hospitals in Edmonton from 1998 to 2002 (inclusive) were reviewed for Achilles tendon ruptures. Data such as gender, age, side, mechanism of injury, and season of injury were obtained. RESULTS: The incidence of Achilles tendon ruptures ranged from an annual average of 5.5 ruptures to 9.9 ruptures per 100,000 inhabitants with an overall mean of 8.3 ruptures per 100,000 people. There was a statistically significant difference in Achilles tendon ruptures over the last two study years for both genders (women, p < 0.02; men, p < 0.03). The mean age for an Achilles tendon rupture was 40.6 years for men and 44.5 years for women. The Achilles tendon ruptures occurred most frequently in the 30 to 39 and 40 to 49 year old age groups in both men and women, respectively (p < 0.02). Most ruptures occurred in the spring season, but there was no statistical difference in the incidence of Achilles tendon ruptures by season (p > 0.05). CONCLUSIONS: The incidence of Achilles tendon ruptures in this community was comparable to those reported in European communities (range 6 to 37 ruptures per 100,000 people), although a bimodal age distribution of rupture previously reported was not observed in this study.     

Bilateral achilles tendon ruptures in a patient with ochronosis: a case report

We report the case of a 67-year-old man with ochronosis who had bilateral Achilles tendon ruptures. We reconstructed the Achilles tendon using pull-out wiring for the right side and an anchoring system for the left side, and reinforced the repair site using the peroneus brevis tendon for both sides. He could walk without a cane at 3 months postoperatively. Tendon ruptures in patients with ochronosis should be treated as pathologic ruptures because histologic examination reveals that both ends of the ruptured tendon and the insertion site at the calcaneus have extensive black pigment depositions where homogentisic acid and its metabolites have accumulated, and there are no normal collagen bundles present. Even if an Achilles tendon rupture is clinically diagnosed as an acute injury, the ruptured Achilles tendon should be primarily repaired and reinforced with autologous tissue because there are a few viable cells at the ruptured site, and because the tendon ruptures mainly at the insertion site of the calcaneus. Although this is a preliminary report, the short-term result is good and the reconstructed sites have showed no rerupture.     

Severe Functional Debilitations After Complications Associated With Acute Achilles Tendon Rupture With 9 Years of Follow-Up

The purpose of the present study was to investigate the long-term effect of deep infection, sural nerve injury, and repeat rupture in the treatment of acute Achilles tendon rupture. A total of 324 patients had made a claim to the Danish Patient Insurance Association from 1992 to 2010 for a complication after acute Achilles tendon rupture. Of the 324 patients, 119 (36.7%) (77 [64.7%] males and 42 [35.3%] females) returned the Achilles tendon total rupture score and the 36-item short-form survey questionnaires. Patients with deep infection (n = 10), sural nerve injury (n = 10), and repeat rupture (n = 16) participated in a follow-up investigation. The mean follow-up period was 8.9 (range 3 to 21) years. The mean Achilles tendon total rupture score was 49 ± 27. The summary scores of the physical component and mental components scales of the 36-item Short Form Survey were 43 ± 11 and 52 ± 11, respectively. No significant differences were found among the subpopulations with deep infection, injury to the sural nerve, or repeat rupture. The physical evaluation investigating tendon length and heel rise work revealed a statistically significant difference between the affected and unaffected limb after repeat rupture (p < .01) but not after injury to the sural nerve (p > .05) or deep infection (p > .05). In conclusion, patients with from a complication after acute Achilles tendon rupture had a remarkable reduction of the Achilles tendon total rupture score and physical component scale score at mean follow-up point of 9 years. Patients with repeat rupture had a significant elongation of the tendon and reduction of strength in the affected limb.     

An Uncomplicated Method for Minimally Invasive Achilles Tendon Repair

The Achilles tendon is the largest palpable tendon in the human body, and rupture of this tendon is not an uncommon injury encountered by foot and ankle surgeons. A number of different minimally invasive methods have been described for repair of the ruptured Achilles tendon. In this article, we describe a relatively simple, minimally invasive technique of Achilles tendon repair that does not require special instrumentation, the key requirement being that of a sponge forceps.     

应用同种异体肌腱移植修复陈旧性跟腱断裂

目的探讨应用同种异体肌腱移植修复陈旧性跟腱断裂的手术方法. 方法 1996年7月～2000年11月,对6例陈旧性跟腱断裂患者行经过深低温处理的同种异体屈指肌腱移植.在跟腱近、远断端间立体双8字交叉移植进行修复,恢复跟腱断端的连续性和强度. 结果术后6例中有5例获2年以上随访,时间27～53个月.5例切口Ⅰ期愈合,1例切口皮缘坏死,经换药愈合.采用Arner-Lindholm疗效评定方法评估获随访的5例术后功能,优1例,良4例. 结论异体肌腱移植修复陈旧性跟腱断裂,可避免自体取材造成的损伤及可能引起的并发症,供材可提前制作,缩短了手术时间,是一种可行的手术方法.     

微创切取全长长屈肌腱重建陈旧性KuwadaⅣ型跟腱断裂

 目的 探讨微创切取全长长屈肌腱重建陈旧性Kuwada Ⅳ型跟腱断裂的临床效果。方法回顾性分析 2006 年7 月至2011 年6月,微创切取全长长屈肌腱重建35例陈旧性KuwadaⅣ型跟腱断裂患者资料,男21例,女14例;年龄为23～71岁,平均42.1岁;均为单侧损伤。MRI 示跟腱断裂间隙为6.0～9.2 cm。观察术后踝关节外形及功能恢复情况,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及Leppilahti跟腱修复评分评价疗效。结果 32例获得随访,随访时间为 18～72个月,平均33.2个月。除1例患者因术后10 d拆线致切口裂开重新缝合6周后获得延迟愈合外,其余患者切口均一期愈合。术后踝关节外形及功能恢复良好,AOFAS踝与后足评分从术前(51.92±7.08)分提高到术后(92.56±6.71)分;其中优27例,良3例,可2 例,优良率为93.8%(30/32)。Leppilahti跟腱修复评分从术前(72.56±7.43)分提高到术后(92.58±5.1)分。无一例发生腓肠神经及胫神经损伤、跖部痛性瘢痕、足底内外侧神经损伤。踝关节MRI示跟腱部信号均匀无撕裂和囊性变。结论 微创切取长屈肌腱转移重建陈旧性KuwadaⅣ跟腱断裂具有术后恢复快、肌腱固定强度高、并发症少的优点。