Achilles tendon tear

Case contributed by Dr Maulik S Patel

Presentation

Left ankle trauma several hours prior to imaging. Presented with pain and swelling in the Achilles tendon region.

Patient Data

Age: 45 years
Gender: Male
X-ray

Tickening of Achilles tendon soft tissue shadow with loss of its anterior outline. There is no fracture / dislocation / bone lesion.

 

Ultrasound

Complete tear of the Achilles tendon about 10 mm from its insertion site. Gap between the two tendon edges of about 35 mm on dorsiflexion. Retracted proximal tendon shows wavy contour, thickening, and tiny bone flake. Distalmost tendon thickness is 5 mm. Plantaris tendon is intact.

Photo

Intra-operative photograph shows a complete tear of the distal Achilles tendon. A stump of about 5-10 mm was attached to the calcaneus. The plantaris tendon was intact. Stump was removed. Distal torn tendon was trimmed and surgically repaired using 3 anchors - double row technique.

Ultrasound

Repaired Achilles tendon reaches to calcaneum. Surgical sutures are present in the tendon substance. There are anchor artifacts at the calcaneal cortex. There is no dislodgement of any anchor. Dynamic scan shows a normal movement of the proximal Achilles tendon. Plantaris tendon is intact.

 

Case Discussion

An adult male had posterior ankle trauma. He was referred for an ultrasound examination with a clinical diagnosis of Achilles tendon tear. Ultrasound shows a complete tear of the distal Achilles tendon with an intact plantaris tendon. Surgical exploration verified an intact plantaris tendon and a complete tear of the Achilles tendon. The torn tendon was surgically repaired.

Intraoperative details, photos and video courtesy of operating surgeon Dr. Ritesh Patel.

Postoperative 3 months ultrasound shows intact repaired Achilles tendon.

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Case information

rID: 62581
Published: 23rd Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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