Revision 5 for 'Achilles tendon tear'All RevisionsChangeset unavailable
Achilles tendon tear
Typically, in a young 'normal' individual, the Achilles tendon ruptures in the 'critical zone', a region of relative watershed hypovascularity 2-6cm proximal to insertion. Due to sports related trauma, especially squash and basketball, males ore well over represented (M:F 5:1 - 6:1). Predisposing condidions include: diabetes mellitus; systemic inflamatory illnesses (e.g. RA, SLE); repeated microtrauma; gout; use of fluoroquinolone antibiotics.
Plain film shows soft tissue swelling and obliteration of pre-Achilles fat pad (Kager's triangle).
MRI appearances vary:
- partial thickness tear shows high signal on long TR, and tendon swelling to >7mm AP
- full-thickness tear shows a tendinous gap filled with edema or blood
- complete rupture shows retraction of tendon ends
- Type 1 Partial ruptures <= 50%
- Type 2 Complete rupture with tendinous gap <= 3 cm
- Type 3 Complete rupture with tendinous gap 3 to 6 cm
- Type 4 Complete rupture with defect of > 6 cm (neglected ruptures)