- Achilles tendon is the thickest and strongest tendon in the human body
- It is also the most commonly ruptured tendon
- Most frequent mechanism is a sudden, forceful contraction of gastrocnemius
- Most common at zone of avascularity 2-6 cm above the calcaneal insertion
- 30-50 years old, recreational athletes (usually playing basketball, racket sports, soccer or softball)
- Sudden pain after a pushing-off movement, audible pop, immediate weakness, palpable defect. Positive Thompson test
- Clinical confounders: tear of other tendons (plantaris, flexor, peroneal), soft tissue edema limiting physical exam by palpation
- In young, active patients, full-thickness tear is frequently treated by surgery. Nonsurgical options are considered in partial-thickness tear, sedentary, and high surgicalrisk patients
Role of Imaging
- To assess if there is an avulsed bone fragment (radiography)
- To differentiate between partial and full thickness tear (ultrasound, MRI)
- Findings of full-thickness tear (both US and MRI): non visualization of tendon, tendon retraction, fat herniation into the tendon gap.
- Additional findings seen on US of full-thickness tear: posterior acoustic shadowing due to refraction of sound beam at the frayed tendon, visualization of plantaris tendon
Our case: ruptured Achilles tendon associated with calcific tendinopathy
1. Hartgerink P, et al. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology 2001; 200:406-412.
2. Skinner HB. Current diagnosis and treatment in orthopedics. McGraw-Hill Professional, 4th edition, 2006.