Presentation
Blunt trauma to the left Achilles tendon region one month before the presentation. Complaining of difficulty in walking.
Patient Data
There is a complete (full-thickness & full-width) tear of the Achilles tendon approximately 50 mm away from the insertion site. The distance between the two edges of the tendon is about 30 mm. The defect is filled with non-fibrillar echoes. The proximal, as well as distal tendon, show thickening with heterogeneous echopattern. The paratenon is intact. The dynamic scan showed absent proximal tendon movement with foot plantar-dorsal flexion. The plantaris tendon is intact.
There is no retrocalcaneal bursitis/ retro-Achilles bursitis.
1st photo shows an explored Achilles tendon which apparently shows continuity due to intact paratenon. 2nd photo shows post Achilles tendon repair status. Surgical steps were V-Y plasty, flexor hallucis longus fixation with interference screw, plantaris reinforcement.
2 mth postOp US
The Achilles tendon shows post-repair status about 50 mm away from the insertion. The tendon shows continuity with the presence of intratendinous and peritendinous sutures. The dynamic scan shows normal tendon movements with foot plantar and dorsal flexion.
The plantaris tendon is intact and incorporated in the Achilles tendon. Flexor hallucis longus is fixed to the calcaneum.
Case Discussion
The case shows a tear of the Achilles tendon and post-operative findings of a repaired tendon.
The dynamic scan is a must to detect a complete tear. The probe should be placed in the long axis cranial to the tear site. Look for the Achilles tendon movement when a patient is doing plantar flexion and dorsal flexion of the foot. If there is no tendon movement, it's a complete tear.
An intact plantaris tendon is easily localized with the Achilles tendon tear because the contrast is created due to tear. If you see a 'white spot' in the hypoechoic Achilles tendon defect, it is likely to be a plantaris. It can be confirmed in two ways: one is to check for fibrillary echopattern, second is to follow it up as well as down.
The post-repair tendon is always thick, heterogeneous with the presence of sutures.
Surgical details and intra-operative photos courtesy: operating surgeon Dr. Ritesh Patel.
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