Spontaneous Achilles Tendon Rupture Research Articles

A Case of Ochronosis with Spontaneous Rupture of Bilateral Achilles Tendon

A 39-year-old male presented to the orthopaedic OPD with complaints of difficulty in walking since 3 months associated with pain over bilateral heel region. The pain was also associated with intermittent popping sound from bilateral ankle joints. Local examination revealed bilateral loss of Achilles tendon contour along with increased range of dorsiflexion and tenderness. Thompson squeeze test and O’Brien needle test were positive indicating rupture of Achilles tendon.

Patients with Achilles Tendon Rupture Are Prone to Develop Ventricular Arrhythmia.

This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. Between June 2014 and July 2020, a total of 29 patients (28 males, 1 female; mean age: 40 ± 9.78 years; range, 21-66 years) who presented to the emergency department within the first three weeks of injury, and were diagnosed with acute spontaneous ATRs and treated with an open Krackow suture technique, were retrospectively analyzed. Fifty-two healthy individuals (47 males, 5 females; mean age: 39 ± 11.45 years; range, 21-66 years) were recruited as a control group from the cardiology outpatient clinic. Clinical data (demographic features and laboratory parameters (serum glucose, creatinine, hemoglobin, white blood cell count, and lipid profile)) and electrocardiograms (ECGs) were collected from medical records. ECGs were evaluated for heart rate and VR parameters of QRS width, QTc interval, cQTd interval, Tp-e interval, and Tp-e/QT ratio. The clinical data and these ECG parameters were compared between groups. There was no statistically significant difference between groups, regarding clinical data (all p < 0.05). Among ECG parameters, heart rate, QRS width, QTc interval, and cQTd interval were similar between groups (all p < 0.05). There were two important statistically significant findings of this research: The mean Tp-e interval was longer (ATR group: 72.4 ± 24.7, control group: 58.8 ± 14.5, p: 0.01), and the Tp-e/QT ratio was higher (ATR group: 0.2 ± 0.1, control group: 0.16 ± 0.4, p: 0.027) in the ATR group. According to the ventricular repolarization disturbances found in this study, patients with ATR may be at a higher risk of ventricular arrhythmia than healthy people. As a result, ATR patients should be assessed for ventricular arrhythmia risk by an expert cardiologist.

Versatility of Local Fasciocutaneous Island Flaps for Resurfacing Soft Tissue Defects Overlying the Achilles Tendon.

Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

Bilateral spontaneous Achilles tendon rupture in a pregnant patient

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Acute spontaneous bilateral rupture of the Achilles tendon

This is a case report of a 67-year-old active, healthy, male patient who played sports. He presented with pain and bilateral ecchymosis in the calf area. Data from the patient’s history, a physical examination and complementary exams confirmed a diagnosis of atraumatic spontaneous bilateral Achilles tendon rupture. Surgical treatment was performed using the percutaneous technique (the Achillon device) bilaterally. In thepostoperative period, the patient used a walking boot with a 3-cm heel lift in maximum equinus for 45 days and in a neutral position until 60 days after the procedure. The patient began rehabilitation with physical therapy and returned to his sporting activities without restrictions. Level of Evidence V; Prognostic Studies; Expert Opinion.

Shear Wave Elastography Findings of Achilles Tendons in Patients on Chronic Hemodialysis and Patients with renal Transplantation

Introduction Achilles tendon which was comprised of tendinous parts of gastrocnemius and soleus muscles is the strongest and the largest tendon in the human body. Chronic renal disease is related to reduced physical activity, exercise capacity. Spontaneous rupture of achilles tendon have been reported in patients with chronic renal disease and degeneratif changes, recurrent microtraumas, hypoxia, chronic acidosis are predisposing factors. The aim of the study is to assess the degeneration of achilles tendon by shear wave elastography to compare the elastographic findings of Achilles tendons in patients on chronic hemodialysis, patients with renal transplantation and healthy adults. Materials and Methods Twenty-five patients who were on chronic hemodialysis at least 5 years, twenty-five renal transplant patients and twenty-five healthy controls were included in this study. The thickness and shear wave velocity (SWV) of the middle thirds of the achilles tendons were measured bilaterally. Results The mean SWV of right achilles was 3,67 cm/sn left achilles was 3,64 cm/sn in hemodialysis group. The mean SWV of right achilles was 4,29 cm/sn left achilles was 4,25 cm/sn in renal transplant group. The mean SWV of right achilles was 6,68 cm/sn left achilles was 6,59 cm/sn in control group. There was a statistically significant difference between the SWVs of hemodialysis group, renal transplant group and control group (p<0,005). Conclusion The achilles tendons in patients with chronic renal failure were softer than in patients with renal transplantation and control group. Chronic tendinopathy cause softening and weakening of the tendon. In the renal transplant group stiffness of the achilles tendon was increased with respect to hemodialysis group but still softer than the control group which could be explained by the positive clinical effect of renal transplantation. In conclusion shear wave elastography is an objective, easy, noninvasive, method that can asssess tendinopathy.

Rupture Spontanee Du Tendon D’achille Sur Terrain Diabetique : A Propos Du Cas

Achilles Tendon Rupture (ATR) is a frequently described lesion in sports traumatology. It can occur following certain chronic or systemic diseases. We reported a case of a 48-year-old woman, a teacher by profession, who was consulting for lameness. Anamnesis found during a walk, a brutal sensation of blow on the heel with cowardice and sharp pain at the elective point imposing upon the resting of the patient. Clinical examination noted an increased spontaneous dorsiflexion of the affected ankle, depression corresponding to the tendon continuity solution, and a positive Thompson test. The diagnosis of Achilles Tendon Rupture was made. The patient was operated 2 weeks later by open surgery. A simple suture kept by a plaster splint was performed (the ankle in equinus). Functional rehabilitation was done for 6 weeks, and walking was allowed at the 6th week. In the absence of minimally invasive surgery, conventional surgery can provide good results in case of spontaneous Achilles Tendon Rupture at the cost of rigorous monitoring of the patient.

A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture

ObjectiveAcute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture. MethodsFifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography. ResultsMean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients. ConclusionsThe novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.

Presence of Bacteria in Spontaneous Achilles Tendon Ruptures

Background: The structural pathology of Achilles tendon (AT) ruptures resembles tendinopathy, but the causes remain unknown. Recently, a number of diseases were found to be attributed to bacterial infections, resulting in low-grade inflammation and progressive matrix disturbance. The authors speculate that spontaneous AT ruptures may also be influenced by the presence of bacteria. Hypothesis: Bacteria are present in ruptured ATs but not in healthy tendons. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with spontaneous AT ruptures and patients undergoing anterior cruciate ligament (ACL) reconstruction were recruited for this study. During AT surgical repair, excised tendinopathic tissue was collected, and healthy tendon samples were obtained as controls from hamstring tendon grafts used in ACL reconstruction. Half of every sample was reserved for DNA extraction and the other half for histology. Polymerase chain reaction (PCR) was conducted using 16S rRNA gene universal primers, and the PCR products were sequenced for the identification of bacterial species. A histological examination was performed to compare tendinopathic changes in the case and control samples. Results: Five of 20 AT rupture samples were positive for the presence of bacterial DNA, while none of the 23 hamstring tendon samples were positive. Sterile operating and experimental conditions and tests on samples, controlling for harvesting and processing procedures, ruled out the chance of postoperative bacterial contamination. The species identified predominantly belonged to the Staphylococcus genus. AT rupture samples exhibited histopathological features characteristic of tendinopathy, and most healthy hamstring tendon samples displayed normal tendon features. There were no apparent differences in histopathology between the bacterial DNA–positive and bacterial DNA–negative AT rupture samples. Conclusion: The authors have demonstrated the presence of bacterial DNA in ruptured AT samples. It may suggest the potential involvement of bacteria in spontaneous AT ruptures.

Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

Spontaneous Achilles Tendon Rupture in a Patient with Undergoing Long-Term Haemodialysis: a Case Report and Literature Review

Chronic kidney disease and hemodialysis are well known risk factors for tendon rupture, although this is a rare situation. The present case was a 70-year old male who presented with a sudden onset of painful disability in the left posterior ankle. This occurred while he was climbing the stairs. A physical examination and imaging resulted in a diagnosis of Achilles tendon rupture. The patient had received regular haemodialysis for 12 years. He developed secondary hyperparathyroidism as excepted sequelae of end stage renal disease. Following surgical repair, physiotherapy and management of associated risk factors, the patient regained full active mobility.

Mini-Open Tenorrhaphy of Acute Achilles Tendon Ruptures

Background: The high incidence of soft tissue complications related to open Achilles repair has driven enthusiasm for developing minimally invasive surgical procedures. The Dresden procedure, which reduces wound-healing issues and avoids sural nerve damage, has recently been published and shows good functional results. Objective: To evaluate medium-term clinical results of procedures using the Dresden mini-open technique on acute Achilles tendon ruptures. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 100 consecutive patients with a mean follow-up of 42.1 months. At follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) score, time to return to work and sports, subjective satisfaction, and complications were registered. An isokinetic test was performed on the first 21 patients of this series at 1 year postoperatively. Results: The mean time to return to work was 56.0 days, and the mean time to return to sports was 18.9 weeks. The mean AOFAS score was 97.7; 98% of patients were satisfied. No complications regarding soft tissues and sural nerve damage were reported. Two reruptures and 5 cases of deep venous thrombosis were observed. The isokinetic evaluation showed good recovery of the involved muscles. Conclusion: The excellent functional and satisfaction results, ease of the procedure, and avoidance of sural nerve damage make the mini-open technique a very attractive alternative for acute, spontaneous Achilles tendon ruptures.

Bilateral Spontaneous Achilles Tendon Rupture without Any Predisposing Factors

Besides spontaneous rupture of achilles tendon is a rare condition which is usually associated with corticosteroid or fluoroquinolon usage, spontaneous rupture of Achilles tendon without any risk factors is extremely rare. In this report we aimed to present clinical features of a case of bilateral spontaneous achilles tendon rupture and tried to investigate potential etiologic factors. A 54 year old man was admitted to our emergency department as complaining bilateral ankle pain at the retrocalcaneal region. He had no trauma, any comorbidities or any drug consumption history. Painful achilles tendon gaps proximal to his ankles had been palpated and bilateral Thompson’s test positivity had been noted (Figures 1 and 2). He was unable to rise upon his toes however he was able to walk. American Orthopedic Foot and Ankle Society Hindfoot Scoring was calculated as 78 points. The rupture had been verified with a magnetic resonance imaging and his laboratory findings were all within normal limits (Figures 3 and 4).The patient did not approve an operation so conservative treatment with dorsiflexion limiting brace was applied and strengthening and stretching exercises of gastrosoleus was suggested. Atraumatic and bilateral cases with achilles rupture should be well investigated whether any systemic factors are coexistent. Besides well known corticosteroids or fluoroquinolone exposure, endocrinologic and rheumatological diseases, hypercholesterolaemia should be evaluated in terms of predisposing causes. Patients who have to use corticosteroids or fluoroquinolone, should be informed about achilles tendon rupture and be suggested do regular physical exercises in order to reduce the rupture risk. Despite predisposing factors, sometimes nothing can be associated with achilles tendon rupture as in our case. Genetic predisposition or a degenerative process of a tendon due to age may be underlying cause like in rotator cuff tears.

Spontaneous Achilles tendon rupture in alkaptonuria

Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs.

Spontaneous Achilles tendon rupture in a diabetic neuropathy patient on long-term hemodialysis

A 65-year-old male presented with a slowly-growing mass over the right heel region in previous 6 months. No pain, disability or limited range of motion was reported as compared with usual daily activities. He has history of non-insulin-dependent diabetes mellitus for 20 years. Diabetic neuropathy resulted in progressive decline in his sensory and motor function of lower extremities in recent 6 years. He underwent regular hemodialysis three times per week for end-stage renal disease in past 10 years. On account of tertiary hyperparathyroidism, …

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images.

Reconstruction of bilateral spontaneous chronic idiopathic Achilles tendon rupture using LARS ligament: Case report

Spontaneous bilateral idiopathic rupture of Achilles tendon is rare and usually results from sudden dorsiflexion of a plantar-flexed foot; the tendon is most often degenerated or diseased, and spontaneous bilateral rupture is not rare in patients suffering from chronic diseases. Management problems relate to reconstruction options and issues with early ambulation and weight bearing. We report a case of idiopathic bilateral Tendo-Achilles (TA) rupture with no obvious disease process, which was initially neglected, and subsequently reconstructed with LARS polyester ligament. The patient could be mobilized early despite bilateral involvement, but developed bilateral wound dehiscence which needed debridement and local flap coverage; aggressive rehabilitation finally leads to an excellent functional outcome. Despite the fact that artificial ligaments allow biointegration and can withstand stresses of early weight bearing, they often lead to wound related problems. Judicious use is advocated and good cases for their use maybe bilateral TA repair in neglected tears with gaps.

Neglected Spontaneous Rupture of the Achilles Tendon in Elderly Patients With Rheumatoid Arthritis

Spontaneous Achilles tendon rupture associated with rheumatoid arthritis (RA) is a very rare complication. In this report, we have experienced neglected spontaneous rupture of the Achilles tendon in 5 elderly RA patients, and report its clinical features and management. These patients had taken corticosteroids for a long time for RA control. Moreover, they did not show any signs, such as click or impact on the rear foot at the moment of the rupture, and had few complaints or obvious symptoms around their ankles or the rear of the foot after the rupture. This suggests that the lack of severe symptoms prevented the early diagnosis of the Achilles tendon rupture, and that this injury had been neglected during treatment for RA. Therefore, careful diagnosis of the Achilles tendon rupture is needed in elderly patients with RA, even if they have little or no history of trauma.

Tenascin-C and type I and III collagen expression in total Achilles tendon rupture. An immunohistochemical study.

Tendon tissue degeneration and changes in collagen composition play a role in spontaneous rupture of the human Achilles tendon. Tenascin-C has been shown to be present in the tissue pathology and changes in tissue loading. We made an immunohistological study of the expression of tenascin-C and type I and III collagens in ruptured human Achilles tendons. Three tissue samples in ten individuals, one from the Achilles tendon rupture and two control samples from four and sixteen centimeters proximal in same tendon were collected at surgery. The specimen were fixed and labelled with specific antibodies to type I and III procollagens (PICP, PINP and PIIINP), mature type III collagen (IIINTP) and tenascin-C. The amount of reacting tissue was evaluated visually and graded on a semiquantitative scale. No difference in the expression of tenascin-C was found between the sites. Instead, mature type III collagen content (p=0.008) and type III collagen synthesis (p=0.016) were significantly increased at the rupture site relative to the control site 2. The amount of newly synthesized type I collagen (PINP, PICP) was relatively high at all sites, as expected. The expression of type III collagen is increased at the rupture site in the human Achilles tendon, but that of tenascin-C remains unchanged. This finding supports a tissue composition alteration background for Achilles tendon rupture, while the role of mechanical loading at the rupture site remains controversial.

Spontaneous atraumatic Achilles tendon rupture in healthy individuals: biomechanical aspect.

Achilles tendon rupture bilaterally secondary to predisposing factors such as steroid, fluoroquinolones, SLE, RA etc. Other factors are well-described in the literature but this is an extremely rare phenomenon in the absence of risk factors. Available reports in healthy athletes, all had history of severe trauma. We report an unusual presentation of bilateral and unilateral spontaneous rupture of Achilles tendon in healthy lifeguards without any marked trauma. Knowledge of training environment will alert the trainers, athletes and surgeons to recognise training environment at risk and take preventive measures.