TENDO-ACHILLES INJURY

ANATOMY

ANATOMY

ANATOMY

MECHANISM• DIRECT BLOW• SUDDEN DORSIFLEXION OF ANKLE• ACCIDENTAL SLIPPAGE INTO

WATER CLOSET HIGHLEVEL LOWLEVEL

• HIGH LEVEL INJURY FOOT DORSIFLEXED AT

TIME OF SLIPPAGE INJURY 3-4cm ABOVE

INSERTION HEAL WELL AFTER REPAIR

LOW LEVEL INJURY

• TRIES TO TAKE OUT FOOT IN PLANTAR FLEXED POSITION• SLICING OF TENDON AT A

LOWER LEVEL• POOR HEALING

CHRONIC• DUE TO GRADUAL WEAKENING OF

TENDON• AGE>40• INVOLVT IN ACTIVE ATHLETICS• H/O TENDINITIS• LOSS OF FLEXIBILITY OF TENDO ACHILLES

SYMPTOMS• SUDDEN PAIN• AUDIBLE SNAP• WEAK PLANTAR FLEXION• PROMINENCE OF ACHILLES

TENDON LOST

SIGNS• TIPTOE STANDING-LAG• PALPABLE DEFECT• THOMPSON’S TEST• O BRIEN’S NEEDLE TEST

THOMPSON’S TEST

INVESTIGATIONS• PLAIN X-RAY-NO BONY INJURY• MRI• PHYSICAL EXAMN DIAGNOSTIC

TREATMENT SURGICAL ACTIVE INDIVIDUALS RERUPTURE INJURY>2 WEEKS RISK OF WOUND HEALING PROBLEMS

NONSURGICAL

• SEDENTARY INDIVIDUALS• HIGH RISK SURGICAL PTS• INC RISK OF WOUND PROBLEMS• CHANCE OF RERUPTURE +

NONSURGICAL• GRAVITY EQUINUS CAST• BELOW KNEE CAST• APPLIED FOR 3 MONTHS• FOLLOWED BY SUPERVISED

STRENGTHENING ACTIVITIES

SURGICAL APPROACH THROUGH MEDIAL

SIDE OF TENDON SHEATHFOOT IN EQUINUS=RESTING

EQUINUS OF OPP ANKLEEDGES APPROXIMATED-bunnel or kessler stitch PLANTARIS REINFORCE REPAIR

CHRONIC RUPTURE

• GASTRONEMIUS FASCIA SUTURED TO DISTAL STUMP• V-Y LENGTHENING OF

GASTRONEMIUS APONEUROSIS• TRANSFER OF FHL TENDON• REPAIR USING PERONEUS BREVIS

COMPLICATIONS

• RERUPTURE• PARTIAL RUPTURE• NECROSIS• SLOUGHING• INFECTION