Achilles Tendon Ruptures

Question 1

Name the 3 blood supplies to the Achilles Tendon

Answer 1

• Musculotendinous junction
• Osseous insertion
• Peritenon

Question 2

Where is the zone of avascularity?

Answer 2

2-6 cm proximal to insertion

Question 3

What creates once the Achilles tendon ruptures?

Answer 3

Tendon stumps that become frayed

Proximal portion retracts

Question 4

What fills the void within the paratenon with a rupture?

Answer 4

Gelatinous then fibrous scar

Question 5

What occurs during Week 1 of tendon healing?

Answer 5

Fibroblastic splint

-Jelly-like bridge of serous and granulation tissue

Question 6

what occurs during week 2 of tendon healing?

Answer 6

Increased paratenon vascularity

Collagen proliferates

Question 7

What occurs during week 3 of tendon healing?

Answer 7

Collagen fibers coalesce and align longitudinally

Cleavage occurs

Question 8

What occurs during week 4 of tendon healing?

Answer 8

Reduced vascularity and edema

Gliding available

Question 9

What week can you begin passive ROM?

Answer 9

Week 3

Question 10

What week can you begin active ROM and WB?

Answer 10

Week 4

Question 11

Describe the person that is commonly affected

Answer 11

Males in 3rd and 4th decade

Weekend warrior

Pre-existing disease

Question 12

Test where you squeeze the mid-portion of the calf and hope to have the foot PF

Answer 12

Thompson-Doherty Squeeze Test

Question 13

MRI is most useful for what type of rupture?

Answer 13

Delayed rupture

Question 14

Explain the disadvantages of conservative treatment

Answer 14

Re-rupture

Decreased strength, power, and endurace

Question 15

Explain the advantages for surgical treatment

Answer 15

Increased strength, power, and endurance

Less re-rupture

Question 16

Two types of Mechanisms of Injury

Answer 16

Indirect and Direct Trauma

Question 17

Pushing off a WB forefoot while extending the knee and contracting the triceps surae

Sudden and unexpected DF of the ankle

Violent DF of a PF foot

Answer 17

Indirect trauma

Question 18

Direct blow by an object causes rupture of the tendon substance

Laceration or GSW

Answer 18

Direct Trauma

Question 19

Explain clinical findings

Answer 19

Hear a snap or tear
Sudden feeling of weakness
Leg will give out
Pain and edema

Question 20

Physical exam findings

Answer 20

Palpable, visible gap
TD squeeze test
Absence of active PF
Knee flexion exam
Needle test

Question 21

Kuwada Classification

Answer 21

I - less than 50% tear
II - defect less than 3 cm
III - defect b/w 3-6cm
IV - defect greater than 6 cm

Question 22

Type I Kuwada treatment

Answer 22

Cast immobilization

Question 23

Type II Kuwada treatment

Answer 23

End to end repair

Question 24

Type III Kuwada treatment

Answer 24

End to end repair

Autogenous tendon graft

Question 25

Type IV Kuwada treatment

Answer 25

Gastroc recession w/ end to end repair and possible autogenous tendon graft