The surgical findings and histopathology are reported in 217 patients (49 females and 168 males, age: 18-66, 70% professional or amateur athletes) with Achilles tendon ruptures. We analysed and compared the history of those patients, taking into consideration following aspects: first onset of symptoms, aggravating and relieving factors, duration of symptoms, previous treatment, injections, clinical examination (local Achilles deformity, pain localisation, gastro-soleus muscle development/atrophy, biomechanical evaluation). All of the patient had US examination. There were 42 cases (19,35%) of partial ruptures. Samples for histopathological examination were always taken from clinically symptomatic and macroscopically injured parts of the tendon. In all cases (both complete and partial rupture) histopathologic picture was similar. Intraoperative evaluation of partial injures always revealed changes within one (in some cases in two) bundles of Achilles tendon. In all cases we could point the bundle with the biggest or asymetrical load and that we believe is the main factor for partial Achilles tendon injury. On the other hand histopathologic evaluation revealed: micro-injuries, fatty metaplasia, degenerative tendon-like tissue and pathologic vessels, but no inflammatory process and no potential for self healing. Mean follow-up is 3 years. In conclusion, on bases of our experience, outcomes and surgical as well as histopathological findings we believe that: Partial rupture of Achilles tendon may be a result of acute injury or a consequence of repeated microinjuries. There are three bundles of Achilles tendon and force transmission direction of each bundle is different. Acute partial Achilles tendon injuries occur during excessive asymmetric loading of the tendon. The injury occurs in the most loaded bundle. Clinically in our study, it is most often the bundle running from the medial head of gastrocnemius muscle or from the soleus muscle. Chronic processes may also be a result of overload (repetitive microtrauma) of one of the Achilles tendon bundles. The goal of operative treatment is to restore full biomechanical function of the tendon (or as similar to physiology as possible) and to restore the ability to correct transmission of contractile forces, which is possible only by careful reconstruction of the three-bundle structure of Achilles tendon. Surgical treatment has also another purpose - to enhance healing process, which in histopathologic examination has been proven to be very limited.
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