ACHILLES TENDON RUPTURE IN A SNOWBOARDER

Abstract

HISTORY: 20 year old male snowboard presented to a ski-area sports medicine clinic with sudden onset of calf and lower leg pain after an off-balanced landing from a jump in the snowboard of the ski area. The patient reported that he was attempting to rotate 180 degrees during the jump (from the left-foot forward position to the right-foot forward position). He lost his balance in mid-air, and landed with extreme dorsiflexion of his feet and flexion of the knees. The patient stated that the calf pain was immediate upon landing from the jump, however he was able to snowboard down the rest of the run and seek medical treatment at the clinic. The patient denied any previous calf muscle, foot or ankle injuries. PHYSICAL EXAM: 20 year old male in moderate pain, complaining of left calf and posterior ankle pain. Musculoskeletal exam Left Knee Exam: No effusion and no palpable joint line tenderness. Full range of motion (0 to 135 degrees). Negative Lachman's, anterior and posterior drawer. No pain with valgus and varus stress. Left Lower Leg Exam: Normal proximal calf muscle bulk. Significant swelling distal calf at 6 to 10 cm proximal of Achilles tendon insertion. Significant pain with palpation of Achilles tendon with palpable defect approximately 6 to 7 cm proximal of calcaneal insertion. Positive Thompson's test (No plantar flexion with calf muscle contraction/squeeze) Left Ankle/Foot Exam: No significant effusions or pain with palpation at lateral or medial malleoli. No anterior ankle joint line pain. Unable to actively plantar flex foot. Significant pain with passive plantar and dorsiflexion of foot. DIFFERENTIAL DIAGNOSIS: Tibia/Fibula fracture, calcaneal fracture, talar dome fracture, ankle sprain, calf muscle strain/tear, Achilles tendon rupture, Plantaris muscle tear/rupture. TEST AND RESULTS: Xrays - Left ankle series with mortisse view - No fractures evident. No widening of joint space. Left tibia/fibula (AP and lateral) - No fractures evident. FINAL/WORKING DIAGNOSIS: Acute and complete rupture of the Achilles tendon TREATMENT AND OUTCOMES: Patient was referred to local orthopedics group and had surgery for repair of a complete achilles tendon rupture. Patient did well in the post-operative period but was lost to follow-up approximately two months following surgery.