scholarly journals Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

2020 ◽  
Vol 9 (10) ◽  
pp. 3380
Author(s):  
Matthias Gatz ◽  
Christoph Spang ◽  
Håkan Alfredson
Keyword(s):  
Literature Review ◽  
Achilles Tendon ◽  
Conservative Management ◽  
Treatment Options ◽  
Achilles Tendon Rupture ◽  
Rehabilitation Program ◽  
Reference Points ◽  
Future Research ◽  
Hyperintense Signal ◽  
Heel Lift

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities.

scholarly journals Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

2021 ◽  
pp. 107110072110385
Author(s):  
Nicola Maffulli ◽  
Nikolaos Gougoulias ◽  
Gayle D. Maffulli ◽  
Francesco Oliva ◽  
Filippo Migliorini
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Achilles Tendon Rupture ◽  
Rehabilitation Program ◽  
Calf Circumference ◽  
Level Of Evidence ◽  
Traditional Group ◽  
Percutaneous Repair ◽  
Patient Reported ◽  
Group 1

Background: Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after percutaneous surgical repair. Methods: Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. Results: At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. Conclusion: Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study. Level of Evidence: Level II, prospective comparative study.

scholarly journals Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kawin K. W. Lee ◽  
Samuel K. K. Ling ◽  
Patrick S. H. Yung
Keyword(s):  
Achilles Tendon ◽  
Loading Rate ◽  
Controlled Trial ◽  
Treatment Options ◽  
Achilles Tendinopathy ◽  
Foot Orthoses ◽  
Significant Difference ◽  
Arch Support ◽  
Motion Capturing ◽  
Heel Lift

Abstract Background Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. Methods Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. Results Participants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. Conclusions Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies. Trial registration NCT04003870 on clinicaltrials.gov 1 July 2019.

Performance of the Achilles Tendon Total Rupture Score Over Time in a Large National Database: Development of an Instruction Manual for Accurate Use

2020 ◽  
Vol 48 (6) ◽  
pp. 1423-1429 ◽  
Author(s):  
Maria Swennergren Hansen ◽  
Katarina Nilsson Helander ◽  
Jón Karlsson ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
National Database ◽  
Future Research ◽  
Item Score ◽  
Level Of Evidence ◽  
Instruction Manual ◽  
Patient Reported ◽  
The Difference

Background: The Achilles tendon Total Rupture Score (ATRS) is a commonly used patient-reported outcome measure for patients with an acute Achilles tendon rupture. The score consists of 10 questions, the last 3 of which include activities that some patients cannot or do not do. No instruction manual has been developed for the ATRS. Hypothesis/Purpose: The purpose was to evaluate the ATRS at 4, 12, and 24 months after a rupture. The hypothesis was that the results at 4 months would be inconsistent when compared with the results at 1 year and 2 years. We also aimed to develop a manual that explains how to use the ATRS. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: This was a mixed-methods study. The first section was a registry study, where prospectively collected data were analyzed. Data were collected 4, 12, and 24 months after rupture. The original score based on 10 items was compared with a score based on the first 7 items adjusted to the same scale as the original score. Density plots and scatterplots were made and differences between the scores were tested using the Mann-Whitney U test. The second section of the study consisted of discussions among the authors, which resulted in a manual for the ATRS. Results: In total, 2790 complete ATRSs were included. The 7-item score significantly overestimated the value of the 10-item score at all time points ( P < .001), but only at 4 months was the difference clinically relevant (9.7 points). Conclusion: When the ATRS is used for short-term evaluation, there is a risk of results being inconsistent because of the last 3 questions. A manual explaining how to use the ATRS was therefore developed. We recommend that the full ATRS together with the manual should be used in future research rather than eliminating the 3 last questions.

Achilles tendon rupture. A protocol for conservative management

1991 ◽  
Vol 81 (9) ◽  
pp. 486-489 ◽  
Author(s):  
RL Blake ◽  
HJ Ferguson
Keyword(s):  
Achilles Tendon ◽  
San Francisco ◽  
Conservative Management ◽  
Sports Medicine ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Memorial Hospital ◽  
Conservative Approach ◽  
Tendon Ruptures ◽  
Saint Francis

The authors discuss surgical versus conservative management of closed Achilles tendon ruptures. They favor a conservative approach in most cases and present arguments to support this preference. They present a protocol for conservative management of closed Achilles tendon ruptures, which has been developed at the Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco.

Traumatic Achilles Tendon Rupture in a Female College Basketball Player

2004 ◽  
Vol 13 (2) ◽  
pp. 151-166
Author(s):  
Christina Davlin ◽  
Jody Jenike
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Previous History ◽  
Early Mobilization ◽  
Rehabilitation Program ◽  
Basketball Player ◽  
Female College ◽  
College Basketball

Objective:To present the case of a Division I female college basketball player with a complete Achilles tendon rupture.Background:A 19-year-old, female college basketball player ruptured her right Achilles tendon during preseason conditioning. She had no previous history of heel cord symptoms.Treatment:The athlete underwent open surgical repair of Achilles tendon. The athlete successfully progressed through a functional rehabilitation program focused on early mobilization and weight bearing. The rehabilitation program was continually modified to address deficiencies and to keep the athlete actively engaged. She was cleared for full, unrestricted activity 15 weeks and 3 days after surgery and returned to game participation in 16 weeks.Conclusions:This case provides evidence that early mobilization and weight bearing can be used while still protecting the repaired tendon.

scholarly journals Risk factors for rerupture after conservative management of acute Achilles tendon rupture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
Kang Lee ◽  
Jong-Hwa Won
Keyword(s):  
Achilles Tendon ◽  
Conservative Management ◽  
Tendon Rupture ◽  
Cox Regression ◽  
Achilles Tendon Rupture ◽  
Achilles Tendinopathy ◽  
Complete Healing ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
History Of

Category: Sports Introduction/Purpose: Recently, results after conservative management for acute Achilles tendon rupture have been improving after the introduction of real time assessment of tendon healing using ultrasonography and introduction of early weight-bearing and functional brace. Yet, many surgeons prefer surgical management of all acute ruptures due to the risk of tendon rerupture. The purposes of this study are to evaluate incidence and pattern of rerupture of Achilles tendon after complete healing, and to investigate factors related to it. Methods: A total of 202 patients with acute Achilles tendon rupture, who underwent conservative management with cast(3 to 7 weeks) and functional brace, were the subjects of this study. In patients having both tendons injured, only one side was randomly selected for analysis. Hence, for 202 patients, migration free survivorship was analyzed using Kaplan-Meier method, and association with possible risk factors was analyzed by Cox regression analysis using proportional hazards model. Factors include age, sex, history of Achilles tendinopathy, cast duration, calf atrophy(mean calf circumference difference at least 2 cm), possibility of SHR(single heel raise), Achilles thickness after complete healing, and insufficient opposition of tendon ends(10mm>gap>5 mm) after cast, initial gap with ankle neutral. Results: Rerupture occurred in 7 of 202 patients. Factors significantly associated with rerupture in Kaplan-Meier survivorship analysis and univariate Cox regression analysis were sex, history of Achilles tendinopathy, calf atrophy, possibility of SHR. When these factors were analyzed by multivariate analysis, possibility of SHR was the only significant factor with a hazard ratio of 3.14. Conclusion: Our data suggest that possibility of SHR requires special attention during the follow-up. The risk of rerupture after conservative management of acute Achilles tendon rupture can be reduced by sufficient recovery of calf muscle strength with early weightbearing and accelerated rehabilitation with aid of ultrasonography.

scholarly journals Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries

2014 ◽  
Vol 2014 (may14 1) ◽  
pp. bcr2013202657-bcr2013202657 ◽  
Author(s):  
R. Singh ◽  
G. Manoharan ◽  
T. S. Moores ◽  
A. Patel
Keyword(s):  
Literature Review ◽  
Achilles Tendon ◽  
Video Game ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Motion Sensing ◽  
Nintendo Wii
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