Achilles Tendon Trauma Flashcards
Where do most Achilles ruptures occur? why?
2-6cm from the insertion (this is the watershed area/ zone of hypovascularity as well as the point of maximal twist in the fibers of achilels tendon)
Where do most Achilles ruptures occur? why?
2-6cm from the insertion (this is the watershed area/ zone of hypovascularity as well as the point of maximal twist in the fibers of achilels tendon)
Describe the fibers of the Achilles tendon.
rotate from medial to lateral in a spiral fashion. The maximal twist is reached about 2-6cm from the insertion.
What are the mechanisms of indirect trauma to the Achilles tendon?
- pushing off a WB forefoot and extended knee
- sudden dorsiflexion of the ankle (as in slipping on a stair)
- violent dorsiflexion of a plantarflexed foot (fall from height)
what are some mechanisms of direct trauma to the Achilels tendon?
laceration with glass
gunshot wounds
direct blow by an object
What is the “hatchet strike defect”?
palpable gap/dell in the posterior ankle
what is the Thompson squeeze test?
(patient prone, flexing the leg)
perform side-to-side compression of the calf; if the tendon is ruptured, there will be no platnarflexion visualized
What is Mattles test?
(patient prone, knee and leg flexed at 90 deg)
if the achilles tendon is ruptured, teh foot will be visualized resting at 90 deg or less. The nonaffected foot will be slightly plantarflexed due to intact Achilles tendon
explain the needle exam.
(patient prone, place needle in the triceps-surae muscle belly above perceived rupture site) With the needle in place, plantarflexion of foot is performed.if the achilles is intact, the needle will move upon plntarflexion of the foot.
what are teh 3 types of suture techniques for open repair of achilles tendon?
Bunnell
Kessler
Krackow
Describe the fibers of the Achilles tendon.
rotate from medial to lateral in a spiral fashion. The maximal twist is reached about 2-6cm from the insertion.
What are the mechanisms of indirect trauma to the Achilles tendon?
- pushing off a WB forefoot and extended knee
- sudden dorsiflexion of the ankle (as in slipping on a stair)
- violent dorsiflexion of a plantarflexed foot (fall from height)
What is the “hatchet strike defect”?
palpable gap/dell in the posterior ankle
what is the ideal repair time for achilles tendon rupture? why?
within the first 7-14 days because that is when the greatest amount of vascularity to the injured site occurs. after that, the injury is no longer in the inflammatory stage of healing and the vascularity to the injury decreases
What surrounds tendon?
epitenon
What is peritenon? (mesotenon)
epitenon + paratenon
Where are tendon sheaths found?
found where tendons change course/direction
Where is paratenon found?
on tendons with a straight pull (ie. Achiles)
What are the sources of vascular supply to the tendon?
- musculotendinous junction
- bone/periosteum interface
- paratenon
What is the name for the most distal end of collagen fibers of the Achilles tendon that inserts into the calcaneus?
Sharpey’s fibers
What are the phases of tendon healing?
inflammatory
proliferative
remodeling
describe the time course for each phase of tendon healing.
inflammatory (48-72 hrs)
proliferative ( day 5)
remodeling (15-28 days)
when is the gap bridged after an achilles tendon rupture?
week 2
when can a patient return to high impact sports after a tendon injury?
month 4- larger collagen bundle formation occurs
what what percentage of resting length does muscle produce the greatest force?
120%
what is a tendon transposition?
re-routing the tendon without detaching it
what is a tendon suspension?
using a tendon to give support to a structure
What is the Krakow stitch favorable for tendon repair?
the suture doesn’t go right thru the tendon like the others do (so does not constrict vascular supply to tendon like some of the other ones do)
what tendon transfer could you do for a ruptured Achilles?
FHL transfer - used to restore plantarflexion of the ankle
plantaris
Where is the surgical incision preferred for open repair of Achilles tendon, and why?
longitudinal incision made medial to the tendon is preferred because of avoidance of sural nerve injury or lesser saphenous vein plexus
What is Toygar’s angle?
measured along the line of the posterior skin surface on the radiograph where the Achilles tendon courses posteriorly as it approaches its insertion site on the calcaneous. This angle is normally greater than 150° but may decrease below that threshold in the setting of Achilles tendon rupture.
