Chronic Achilles tendon rupture

 

Management Tendon defect size after resection of scar tissue

Diagnosis Diagnosis for acute AT rupture is straightforward Nevertheless, 20% can be missed

Chronic Achilles tendon rupture AT Rupture diagnosed 4 - 6 weeks after injury



V-Y advancement V-Y tendon plasty apex of the V at the tendinous portion of myotendinous junction

Management Tendon defect size after resection of scar tissue



Diagnosis & Treatment
Diagnosis 
Chronic rupture, Achilles tendon, right 

Treatment plan…
Primary repair 
V-Y advancement 
Turn down flap
FHL transfer 


Chronic Achilles tendon rupture 
AT Rupture diagnosed 4 - 6 weeks after injury

1 week after injury, gap between tendon ends fills with scar tissue
Tendon heals elongated
Unable to push off
Compromised running, jumping, ascending/descending stairs
Calf atrophy

Diagnosis
Diagnosis for acute AT rupture is straightforward
Nevertheless, 20% can be missed

Why be missed?
Pain and swelling quickly subside
Active plantar flexion may be weak, but possible
Compensatory activity of tibialis anterior, FHL, FDL
High grade of suspicion level !!  

Special physical tests
US
MRI
Low signal intensity on T1 WI
Discontinuity and altered(mixed increased) signal on T2 WI 
Cf) Normal appearance : dark, smooth contour, low signal on all sequence
Management 
Most surgeons agree that chronic ruptures should be treated operatively
Tendon ends are retracted and atrophied
Repair is preferable but often is not possible

Various surgical techniques
Primary repair 
Augmentation
Fascia advancement
Local tendon transfer
Synthetic or allograft 


Management
Tendon defect size after resection of scar tissue

Myerson classification (ICL, 1999) 


V-Y advancement
V-Y tendon plasty
apex of the V at the tendinous portion of myotendinous junction 


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