Rupture distale du tendon calcanéen par avulsion osseuse : réinsertion transcalcanéenne par ancres. À propos d’un cas avec revue de la littérature

Abstract

The Achilles tendon ruptures are increasing. Its localization is mostly in the middle of the tendon. The distal rupture is rare and is often observed in elderly people. Avulsion of the calcaneus is an exceptional form. A 48-year-old man playing football consults with a distal left Achilles tendon rupture in a context of degenerative tendinopathy for 6 months before the rupture. An ultrasound objectified a microfissure enthesitis next to the posterior superior corner of the calcaneus tendon bursitis and was confirmed on MRI. The patient had received a steroid injection by his general practitioner. He consulted at the urgencies within 15 days with typical symptoms of a ruptured Achilles tendon. By surgery, we found a bony avulsion of the tendon insertion with inflammatory and degenerative appearance. Two anchors intraosseous were displayed, ensuring the distal tendon. A resin boot was crafted for two months then a simple self-rehabilitation without support was prescribed. The functional outcome was assessed by measuring the strength of the triceps surae. Most surgical techniques are not feasible in the case of calcaneal avulsion. Transcalcaneal reintegration by two anchors is a solution that provides strength and good functional outcome.