Achilles Tendon Ruptures Flashcards
Name the 3 blood supplies to the Achilles Tendon
- Musculotendinous junction
- Osseous insertion
- Peritenon
Where is the zone of avascularity?
2-6 cm proximal to insertion
What creates once the Achilles tendon ruptures?
Tendon stumps that become frayed
Proximal portion retracts
What fills the void within the paratenon with a rupture?
Gelatinous then fibrous scar
What occurs during Week 1 of tendon healing?
Fibroblastic splint
-Jelly-like bridge of serous and granulation tissue
what occurs during week 2 of tendon healing?
Increased paratenon vascularity
Collagen proliferates
What occurs during week 3 of tendon healing?
Collagen fibers coalesce and align longitudinally
Cleavage occurs
What occurs during week 4 of tendon healing?
Reduced vascularity and edema
Gliding available
What week can you begin passive ROM?
Week 3
What week can you begin active ROM and WB?
Week 4
Describe the person that is commonly affected
Males in 3rd and 4th decade
Weekend warrior
Pre-existing disease
Test where you squeeze the mid-portion of the calf and hope to have the foot PF
Thompson-Doherty Squeeze Test
MRI is most useful for what type of rupture?
Delayed rupture
Explain the disadvantages of conservative treatment
Re-rupture
Decreased strength, power, and endurace
Explain the advantages for surgical treatment
Increased strength, power, and endurance
Less re-rupture
Two types of Mechanisms of Injury
Indirect and Direct Trauma
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
Indirect trauma
Direct blow by an object causes rupture of the tendon substance
Laceration or GSW
Direct Trauma
Explain clinical findings
Hear a snap or tear
Sudden feeling of weakness
Leg will give out
Pain and edema
Physical exam findings
Palpable, visible gap TD squeeze test Absence of active PF Knee flexion exam Needle test
Kuwada Classification
I - less than 50% tear
II - defect less than 3 cm
III - defect b/w 3-6cm
IV - defect greater than 6 cm
Type I Kuwada treatment
Cast immobilization
Type II Kuwada treatment
End to end repair
Type III Kuwada treatment
End to end repair
Autogenous tendon graft
Type IV Kuwada treatment
Gastroc recession w/ end to end repair and possible autogenous tendon graft
