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Achilles Tendon
Achilles Tendon
Achilles Tendon
M.Mazloumi MD
Anatomy
Largest
tendon in
the body
Origin from
gastrocnemius and
soleus muscles
Insertion on
calcaneal
tuberosity
Anatomy
Lacks
Paratenon
Anatomy
Paratenon
Anterior
richly vascularized
The remainder multiple thin membranes
Anatomy
Blood supply
1)
2)
3)
Musculotendinous junction
Osseous insertion on calcaneus
Multiple mesotenal vessels on anterior
surface of paratenon (in adipose)
Anterior mesentery
Physiology
Remarkable
response to stress
Exercise
Biomechanics
Gastrocnemius-soleus-Achilles
Spans
complex
3 joints
Flex
knee
Plantar flex tibiotalar joint
Supinate subtalar joint
Up
Repetitive
microtrauma in a
relatively
hypovascular area.
Reparative
process
unable to keep up
May be on the
background of a
degenerative
tendon
tendinitis/tendinosis in 11%
75%
Most
Complete
Defect
Can
Imaging
Ultrasound
Inexpensive
, dynamic
examination possible
Good
Imaging
MRI
Expensive
Better
at detecting
1-partial ruptures
2- staging degenerative
changes
3- monitor healing
Management Goals
Restore
tension.
Optimize
function
Avoid
ankle stiffness
Conservative Management
Cast in Plantarflexion
2 wks
Start a strengthening
program
2- 4 weeks
Functional Bracing
Surgical Management
Preserve
supply
Beware of sural nerve
Debride and approximate tendon ends
Use 2-4 stranded locked suture
technique
May augment with absorbable suture
Close paratenon separately
Surgical Management
Kerachow suture technique
Surgical Management
Lynn technique
Percutaneous repaire
Old rupture
Bosworth technique for repairing old
ruptures of Achilles tendon
Open repair
Surgical Management :
Post op Care
Assess
Conservative vs Surgical
Acute rupture of tendon Achillis. A prospective randomised study of
comparison between surgical and non-surgical treatment.
Moller M, et al. J Bone Joint Surg Br. 2001 Aug;83(5):863-8
112 patients
Casted x 8 wks
Surgery +
Early functional rehab in
brace
21 % re-rupture
1.7% re-rupture
No difference in
functional outcome
5%
infection
Conservative vs Surgical
Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative
treatment with immediate full weightbearing--a randomized controlled trial.
Am J Sports Med. 2008 Sep;36(9):1688-94. Epub 2008 Jul 21.
83 patients
Casted x 8 wks
Surgery +
Early functional rehab in
brace
5 \ 41 re-rupture
3 \ 42 re-rupture
No difference in
functional outcome
0.5%
infection
2.
3.