Materiały źródłowe

• #1 Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7804867/

  The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. […] Achilles tendon ruptures (ATRs) occur mainly during sports activities, more frequently in middle-aged men, especially untrained and recreational athletes who play sports occasionally, even though ruptures can occur in younger people. The incidence of ATRs has increased over the last several decades, probably as a result of widespread sports participation. […] The poor vascularity in the main body of the Achilles tendon may play an important role in the pathogenesis of the rupture. […] Acute ATRs are classically produced by a single high-load impact (for example, an ATR associated with sudden or violent dorsiflexion of ankle or lunge).

• #2 Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

  https://www.mdpi.com/2411-5142/5/4/95

  The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. […] Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades. […] The poor vascularity in the main body of the Achilles tendon may play an important role in the pathogenesis of the rupture. […] Acute ATRs are classically produced by a single high-load impact (for example, an ATR associated with sudden or violent dorsiflexion of ankle or lunge). […] Moreover, an acceleration-deceleration mechanism has been reported in up to 90% of sports-related ATRs. […] Degenerative changes are the most common histological findings in spontaneous tendon ruptures (such as high vascularity, collagen disorganization and hypercellularity relatively close to the ruptured site) and may lead to reduced tensile strength and a predisposition to rupture.

• #3

  https://www.orthobullets.com/foot-and-ankle/7021/achilles-tendon-rupture

  Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. […] Mechanism: usually traumatic injury during a sporting event. […] may occur with sudden forced plantar flexion. […] violent dorsiflexion in a plantar flexed foot. […] rupture usually occurs 4-6 cm above the calcaneal insertion in hypovascular region.

• #4 Achilles Tendon Injuries: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/309393-overview

  Tendon rupture is almost always the terminal event in the ongoing degenerative process of the tendon, as confirmed in histologic studies of ruptured tendons. […] The most common mechanisms of injury include sudden, forced plantar flexion of the foot; unexpected dorsiflexion of the foot; and violent dorsiflexion of a plantar-flexed foot. Other mechanisms include direct trauma and, less frequently, attrition of the tendon as a result of longstanding paratenonitis, with or without tendinosis. […] Achilles tendon rupture resulting from forced dorsiflexion during active plantar flexion is commonly seen in basketball, diving, tennis, and other sports that require forceful push off from the foot. […] Although a link between smoking and biceps tendon rupture has been proven, no association between smoking and Achilles tendinosis or rupture is reported in the literature.

• #5 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults in their third to fifth decade of life. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Achilles tendon rupture causes significant pain and disability. […] Causes of Achilles tendon rupture include sudden forced plantar flexion of the foot, direct trauma, and long-standing tendinopathy or intratendinous degenerative conditions. Sports often associated with Achilles tendon rupture include soccer, basketball, and racquet games. Risk factors for a rupture of the Achilles tendon include poor conditioning before exercise, prolonged use of corticosteroids, overexertion, fluoroquinolone antibiotics, oral bisphosphonates, and previous Achilles tendinopathy, diabetes, hyperparathyroidism, and genetic factors.

• #6 Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7804867/

  Moreover, an acceleration-deceleration mechanism has been reported in up to 90% of sports-related ATRs. […] Degenerative changes are the most common histological findings in spontaneous tendon ruptures (such as high vascularity, collagen disorganization and hypercellularity relatively close to the ruptured site) and may lead to reduced tensile strength and a predisposition to rupture. […] A reduction in the number and diameter of type I collagen fibers that account for 95% of Achilles tendon collagen, replaced with larger type III fibers that are produced by ruptured Achilles tendon and that are less resistant to tensile forces, are also present. […] In addition, there are several other factors which play a role in the pathogenesis of ATR, including: gastrocnemius-soleus dysfunction, sub-optimally conditioned musculotendinous unit, age, gender, changes in training pattern, poor technique, previous injuries, footwear, poor tendon vascularity, and various pathologic conditions, such as infectious diseases, neurologic conditions hyperthyroidism, renal insufficiency, diabetes, arteriosclerosis, inflammatory and autoimmune conditions, hyperuricemia, genetically determined collagen abnormalities, and high serum lipid concentration. […] Drugs such as anabolic steroids and fluoroquinolones cause dysplasia of collagen fibrils, which decreases tendon tensile strength and increases the risk of ATR.

• #7 The Injury Mechanism of Achilles Tendon Rupture in Professional Athletes: A Video Analysis Study in: Journal of the American Podiatric Medical Association Volume 114 Issue 3 (2024)

  https://japmaonline.org/abstract/journals/apms/114/3/21-196.xml

  In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture in professional athletes. […] We hypothesized that Achilles tendon ruptures in professional athletes develop with a specific injury mechanism and that body posture at the time of injury varies by sport. […] During Achilles tendon rupture, the ankle was in dorsiflexion, the body was bent forward, the knee and hip were in extension, and the foot was in a neutral position. Most injuries occurred during take-off/acceleration (40.5%) or stop and turn (38.5%) maneuvers. […] In professional athletes, the Achilles tendon most often ruptures during take-off/acceleration. The most common position during rupture is the trunk in flexion, the knee and hip in extension, and the ankle in dorsiflexion. This information can guide professional athletes in terms of physical therapy techniques, including neuromuscular training, proprioception, and balance training specific to preventing Achilles tendon rupture.

• #8 030 A systematic video analysis of the mechanism of injury of achilles tendon ruptures | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/55/Suppl_1/A12.2

  There is currently limited evidence identifying the mechanism of Achilles tendon rupture (ATR). […] Determine the movement pattern (mechanism of injury) for ATRs. […] High load eccentric activity of the plantarflexor muscles was identified as occurring in all injuries. This was associated with dorsiflexion of the ankle and concurrent knee extension in 100% of subjects. […] The injury mechanism for Achilles tendon rupture involves dorsiflexion of the foot with knee extension, whilst the plantarflexor muscles are eccentrically contracting.

• #9 Achilles Tendon Rupture – OrthoPaedia

  https://www.orthopaedia.com/achilles-tendon-rupture/

  The most common acute injury to the Achilles tendon is a complete rupture. […] Achilles tendon ruptures usually occur when an athlete loads the Achilles immediately prior to pushing off. […] A sudden change in direction requires the calf muscle to contract while still lengthening (eccentric loading). This subjects the Achilles tendon to a large loading force, which may cause the tendon to fail. […] To be clear, the tendon tears because of the large internal forces generated by the eccentric contraction of the calf muscle and applied to the Achilles – and not because of an external force. […] Achilles tendon tears are more common in middle-aged men who exercise intensely but intermittently (the so-called “weekend warrior”). […] With age the Achilles tends to lose flexibility and may develop areas of tendonosis (degenerative changes) that can serve to weaken the tendon.

• #10 Achilles Tendon Rupture – Orthopaedia: Foot & Ankle

  https://pressbooks.pub/frontlinefootandankle/chapter/achilles-tendon-rupture/

  The most common acute injury to the Achilles tendon is a complete rupture. This injury typically occurs in men in their 30s and 40s. Ruptures typically occur 2 to 5 cm proximal to insertion into the calcaneus. […] Achilles tendon ruptures usually occur when an athlete loads the Achilles immediately prior to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. A sudden change in direction requires the calf muscle to contract while still lengthening (eccentric loading). This subjects the Achilles tendon to a large loading force, which may cause the tendon to fail. To be clear, the tendon tears because of the large internal forces generated by the eccentric contraction of the calf muscle and applied to the Achilles and not because of an external force.

• #11 Video analysis of Achilles tendon rupture in male professional football (soccer) players: injury mechanisms, patterns and biomechanics | BMJ Open Sport & Exercise Medicine

  https://bmjopensem.bmj.com/content/8/3/e001419

  Achilles tendon rupture (ATR), while rare in football, is a severe career-threatening injury associated with long-layoff times. […] To date, no study has documented ATRs mechanism in professional football players. […] ATRs happen with a pure non-contact mechanism in 83% of professional football players. […] ATRs are mainly acceleration injuries in football, and three main patterns have been described: (1) acceleration from standing, (2) cross-over cutting and (3) vertical jumping. […] All ATRs in professional football were either non-contact (83%) or indirect contact (17%) injuries. The most common situational patterns were forward acceleration from standing, cross-over cutting and vertical jumping. Biomechanics was consistent and probably triggered by a multiplanar, although predominantly sagittal, loading of the injured Achilles tendon.

• #12 Video analysis of Achilles tendon rupture in male professional football (soccer) players: injury mechanisms, patterns and biomechanics | BMJ Open Sport & Exercise Medicine

  https://bmjopensem.bmj.com/content/8/3/e001419

  ATRs in football are non-contact (83%) or indirect (17%) contact injuries. They occur largely (85%) with three main patterns: (1) acceleration from standing, (2) cross-over cut and (3) vertical jumping. ATR predominantly involves altered multiplanar kinematics, with an extension pattern at the knee and hip and the ankle close to end-range dorsiflexion, combined with foot pronation and external rotation. […] ATR occurs when the mechanical limits of the tendon are overcome by high internal muscle forces. […] The triceps surae muscle group has recently been shown to be an important contributor to force generation during propulsion tasks. […] We reported a high incidence of foot pronation during ATR, particularly during cross-over cut (all cases with identifiable footage). […] Excessive pronation can create a whipping or torsional action on the AT, stressing the mid-substance.

• #13 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  The pathophysiology of Achilles tendon ruptures involves a combination of mechanical, structural, and biomechanical factors. Mechanical factors: The Achilles tendon is the strongest tendon in the body, in part due to its configuration. However, it can rupture when the tendon is suddenly exposed to excessive tensile loads. Structural factors: The Achilles tendon comprises mainly dense, parallel, type 1 collagen fibers organized into fascicles. As people age, parallel collagen fibers become less organized and more prone to degeneration. Biomechanical factors: Stiffness is associated with potential risk factors for Achilles injuries, while high foot arches decrease the risk of Achilles injuries. […] The Achilles tendon typically ruptures 2 to 6 cm above the calcaneal insertion. This area is where its tendon fibers twist and blood supply is diminished. Studies have found reduced capillary oxygenation and microperfusion at 5 cm above the calcaneal tubercle compared with 1 cm above the tendon insertion.

• #14 Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

  https://www.mdpi.com/2411-5142/5/4/95

  A reduction in the number and diameter of type I collagen fibers that account for 95% of Achilles tendon collagen, replaced with larger type III fibers that are produced by ruptured Achilles tendon and that are less resistant to tensile forces, are also present. […] In addition, there are several other factors which play a role in the pathogenesis of ATR, including: gastrocnemius-soleus dysfunction, sub-optimally conditioned musculotendinous unit, age, gender, changes in training pattern, poor technique, previous injuries, footwear, poor tendon vascularity, and various pathologic conditions, such as infectious diseases, neurologic conditions hyperthyroidism, renal insufficiency, diabetes, arteriosclerosis, inflammatory and autoimmune conditions, hyperuricemia, genetically determined collagen abnormalities, and high serum lipid concentration. […] Drugs such as anabolic steroids and fluoroquinolones cause dysplasia of collagen fibrils, which decreases tendon tensile strength and increases the risk of ATR.

• #15 Achilles tendon tear | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/achilles-tendon-tear?lang=us

  Achilles tendon tears are the most common tendon ruptures. They are commonly seen secondary to sports-related injuries, especially squash and basketball. The spectrum of tears ranges from microtears to interstitial tears (parallel to the long axis of the Achilles), to partial tears, and eventually to complete tears (ruptures). Tears can be acute or chronic, with repeated minor trauma. At the mildest end of the spectrum all that may be present is peritendonitis. Typically, in a young individual with a normal Achilles tendon ruptures in the „critical zone”, which is a region of relative watershed hypovascularity 2-6 cm proximal to insertion.

• #16

  https://link.springer.com/article/10.1007/s12306-013-0251-6

  They concluded that hypovascularity coupled with repeated trauma, together preventing regeneration, can lead to rupture. […] Another study reported degenerative changes in all 74 patients, also implicating poor blood supply. […] The intra-tendinous vessels and the relative area occupied by these blood vessels are known to be lowest at this zone. […] Ageing affects all collagenous structures in the body including the AT. […] These changes could lower the threshold for microscopic collagen fibril tears and increase the likelihood of damage. […] Chronic tendinosis may sometimes manifest itself as calcification within the Achilles tendon. […] The mechanical theory relates to the peak incidence occurring in the middle aged rather than in the elderly. […] Inglis and Sculco suggested that a malfunction in the inhibitory mechanism protecting against excessive or uncoordinated muscle contractions could cause rupture at the site of maximum stress and torsion.

• #17

  https://link.springer.com/article/10.1007/s12306-013-0251-6

  Although most AT ruptures (4483 %) occur during sport, intrinsic structural, biochemical and biomechanical changes may be important. […] Controversy surrounding best treatment exists because outcomes are determined by the repair method and also post-operative functional rehabilitation. […] Specifically, the risks and benefits of open versus closed treatment continue to be debated and the safest, cost-effective method remains undecided. […] Multiple attributing factors and associations with other medical disorders have been described in AT rupture. […] Two main explanations exist: the degenerative and mechanical theories. […] Risk factors for rupture include corticosteroids, fluoroquinolone antibiotics and hyperthermia. […] Early experiments supported the degeneration theory and Langergren and Lindholm showed that ruptures were usually limited to a segment about 26 cm proximal to the calcaneal insertion.

• #18 An Uncommon Mechanism for Work-Related Total Achilles Tendon Rupture – Journal of Urgent Care Medicine

  https://www.jucm.com/uncommon-mechanism-work-related-total-achilles-tendon-rupture/

  Achilles tendon (AT) ruptures account for approximately 40% of all operative tendon repairs. With 18 ruptures per 100,000 people, it is the most frequently ruptured tendon and the incidence of AT ruptures has been steadily increasing over the past few decades. […] The degenerative theory states that asymptomatic and chronic degeneration of the AT associated with age predisposes the AT to rupture, even without severe force applied to the tendon. The mechanical theory suggests that AT rupture can occur due to nondegenerative acute and subacute microtrauma and microruptures of the tendon, causing failure under a high degree of stress. The proposed mechanical theory is consistent with the most common mechanism of an AT rupture, which occurs when the muscle is maximally contracted and the tendon is obliquely loaded at a short initial length. […] It should be noted for future similar injuries, that a direct impact to the AT, even of an unusual mechanism, in combination with muscle contraction and weight bearing is a possible mechanism of injury.

• #19

  https://link.springer.com/article/10.1007/s12306-013-0251-6

  Athletes returning after inactivity may be most susceptible to this mechanism. […] Therefore, a violent muscular force could cause rupture from incomplete synergism of agonist muscle contractions, inefficient plantaris action or a difference in the muscle-tendon thickness quotient. […] In a study of 109 runners, Clement et al. demonstrated that AT injury may be due to structural or dynamic disturbances such as overtraining, functional over-pronation and gastrocnemius-soleus insufficiency. […] Again they concluded that repeated microtrauma from eccentric loading of fatigued muscle led to multiple microruptures and eventual failure beyond a critical point. […] Both systemic and local corticosteroids have been implicated in AT rupture. […] Indeed, their anti-inflammatory properties may initially mask underlying tendinopathy symptoms.

• #20 Achilles tendon rupture – UpToDate

  https://www.uptodate.com/contents/achilles-tendon-rupture

  Achilles tendon rupture occurs in 8.3 percent of competitive athletes. Competitive athletes with a high lifetime incidence of tendon rupture include sprinters (18 percent), decathletes (17 percent), football (soccer) players (17 percent), track and field jumpers (12 percent), basketball players (12 percent), and ice hockey players (9 percent) [6]. […] Increased age, male sex, and obesity are risk factors for Achilles tendon problems (table 1) [7-9]. The peak age for rupture is 30 to 40 years for both men and women; this may be when degenerative changes and occasional high stress from sports coincide. Rupture is four to five times more common in men than women [1]. […] As participation in recreational sports has increased over the past 50 years, so has the rate of tendon rupture [10]. Achilles tendon rupture is rare among children and more likely to be sustained through direct, often penetrating, trauma [11].

• #21 Achilles Tendon Rupture FAQ’s | Complete Orthopedics

  https://www.cortho.org/faq/foot-ankle/achilles-tendon-rupture/

  The tendon heals vast majority of the time. However, the length of the tendon is important. If the tendon heals too long, we lose the biomechanical advantage of the tendon. This results in weakness, fatigability, and limitation in activity. The goal of any treatment (surgery vs no surgery) is to get the tendon to heal at the appropriate length. […] The use of Fluoroquinolone antibiotics is associated with rupture of the Achilles tendon and tendonitis of all tendons. The risk of a rupture is 4 times more likely in those patients with recent fluoroquinolone use, and 46 times more likely in those patients with recent fluoroquinolone and corticosteroid exposure. […] Chronic Achilles tendon inflammation (tendonitis) can result in collection of scar tissue and inflammatory material in the tendon itself. This is called tendonosis. This tissue is not like your normal Achilles tendon. It causes pain and does not contribute to the tensile strength of the tendon. Over time, a significant portion of the tendon can be replaced with this unhelpful inflammatory tissue. This means that there is more force moving through the unaffected fibers. This placed the tendon at higher risk of rupture. […] Typically, when we discuss Achilles ruptures, it refers to a complete tendon rupture. This means all the tendon fibers are disrupted. However, some patients have partial tears, where some fibers are preserved. Treatment depends on how much of the tendon is torn.

• #22 Spontaneous Unilateral Achilles Tendon Rupture With Corticosteroid Use for Microscopic Polyangiitis | Fok | Journal of Medical Cases

  https://www.journalmc.org/index.php/jmc/article/view/1296/642

  Achilles tendon rupture is increasingly reported in patients treated with corticosteroid and fluoroquinolones. […] Spontaneous non-traumatic rupture of the Achilles tendon is rare but can be associated with long-term use of systemic corticosteroids, fluoroquinolones or both. […] The mechanism of steroid-induced Achilles tendinopathy is not clearly understood. Suppressed repair mechanism of partially injured tendons may extend to complete rupture even after gentle locomotion. […] Reduced tensile strength of the tendon due to collagen fibrils dysplasia as a result of steroid use has also been proposed. […] High-dose systemic corticosteroid therapy, in association with other risk factors such as quinolone antibiotics, connective tissue disease, and severe renal impairment, predisposes to spontaneous Achilles tendon rupture.

• #23 The Achilles tendon: Management of acute and chronic conditions

  https://www1.racgp.org.au/ajgp/2020/november/the-achilles-tendon

  Achilles tendon injuries can be divided into acute ruptures and chronic overuse injuries. […] Acute rupture of the Achilles tendon is a common injury, accounting for 20% of all large tendon ruptures. […] This injury has a bimodal distribution, with the first peak occurring in people aged 25-40 years who are participating in high-energy sports, and the second peak in people aged 60 years. […] The risk of rerupture is higher in elderly patients with a degenerative tendon because of the inherent poor quality and diminished vascular supply of the tendon fibres. […] In the younger population, histological studies performed on acute Achilles tendon ruptures have shown clear degenerative changes despite little or no symptoms pre-injury. […] Fluoroquinolone antibiotics (commonly ciprofloxacin) have a known association with Achilles tendinitis and rupture, with a latency period of between two and 60 days.

• #24 Achilles Tendon Injuries: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/309393-overview

  Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined nomenclature has evolved: […] Partial or full tendon ruptures may result from end-stage paratenonitis. Causes of tendon pathologies, including ruptures, are associated with multiple intrinsic and extrinsic factors (see Etiology). […] Tendon histopathology has been divided into the following 4 categories: Cellular activation and increase in cell numbers, Increase in ground substance, Collagen disarray, Neovascularization: However, some more recent studies comparing the degree of neovascularization and the severity of Achilles tendinosis have failed to link a direct relationship.

• #25

  https://actaorthop.org/actao/article/view/19711

  Spontaneous rupture of AT seems to be preceded by widespread, bilateral damage of the tendon and widespread ipsilateral acute inflammation. […] On histological examination, collagen degeneration, tenocyte necrosis, and acute inflammation were found at the rupture site in all cases. […] The severity of the histological changes decreased from the rupture site to the proximal part to the site of insertion, and showed no relation to the age of the patients or the time from the rupture to the operation.

• #26 SciELO Brazil – Achilles Tendon Lesions – Part 2: Ruptures Achilles Tendon Lesions – Part 2: Ruptures

  https://www.scielo.br/j/rbort/a/XPM5hFcJr9mqqcGTZWTKDZM/

  Tendon rupture causes a natural separation between its ends. Right after injury, local bleeding and regional inflammatory signaling lead to the start of reparative tissue formation. Persistence of muscle contraction and local mobilization promotes a proximal migration of the triceps and consequent adherence of the stumps to the paratendon and adjacent tissues. An elongated fibrous scar tissue, with no mechanical capability, usually forms at the rupture zone. In some cases, there is no healing scarring formation and a major defect is established. Whatever the outcome, there is a substantial sural tricipital weakness due to musculotendinous unit stretching or the lack of communication between origin and attachment. […] The concentration of tissues devoid of native tensile, elastic and biological capacity weakens tendons and predisposes them to macroscopic tears. Authors stated that these tears would result from loads applied by a maximum muscle contraction in a tendon in its initial stretching phase. This risk would be potentiated by a failure in the ability of the body to control excessive and uncoordinated contractions, which are common findings in athletes under erratic training. Reported rupture mechanisms occur mainly during the detachment phase (start of running or jumping) with the knee extended (53% of the cases), followed by inadvertent treading on a hole (17%) and abrupt extension of a flexed ankle (10%).

• #27 Achilles Tendon Rupture – WikiSM (Sports Medicine Wiki)

  https://wikism.org/Achilles_Tendon_Rupture

  Degenerative changes are common histopathological findings after ATR. […] High vascularity. […] Collagen disorganization. […] Hypercellularity relatively close to the ruptured site. […] Likely predispose/ increase risk of rupture. […] There is often a reduction in the type I collagen fibers that make up 95% of the Achilles. […] Replaced with larger type III collagen fibers, which are less resistant to tensile forces. […] After rupture, tendons heal forming scar tissue. […] Most will never regain the same collagen structure, composition, and organization of healthy tissue. […] Can cause a decrease in mechanical properties, increase risk for re-rupture. […] Classically produced by a single, high-low impact with sudden or violent dorsiflexion of ankle. […] Acceleration-deceleration mechanism is reported in 90% of ATR. […] This is most common during sports and recreation. […] Typically occurs in the midportion, 2-6 cm proximal from the insertion on the calcaneus. […] This is partially due to the poor vascularity in this part of the tendon.

• #28 Nonoperative Management of Achilles Tendon Rupture: A Clinical Debate

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/19789/JPJ/fullText

  When assessing both operative and nonoperative management, tendon healing occurs in three main phases: hemorrhagic/inflammatory, proliferative, and remodeling. […] With respect to the theory behind the accelerated functional rehabilitation protocol, the Wolffs law for tissue regeneration states that tissue will remodel in response to mechanical load, so-called form follows function. […] Since the introduction of the accelerated functional rehabilitation protocol, several studies have supported the use of nonoperative management in the patient with a ruptured Achilles tendon over operative management. […] Treating patients nonoperatively must take place in patients who have presented to the department no longer than 48 hours post injury and immediately placed in an equinus cast. […] By treating patients nonoperatively with the accelerated functional rehabilitation protocol, rerupture rates are equal, as is strength, return to work, return to sport, range of movement, and functional outcomes.

• #29 The Achilles tendon: Management of acute and chronic conditions

  https://www1.racgp.org.au/ajgp/2020/november/the-achilles-tendon

  Management of acute Achilles tendon ruptures continues to be debated, but there is emerging evidence that supervised non-operative management results in very good outcomes. […] A Cochrane review reported a higher rerupture rate of 12% with non-operative treatment, compared with 5% in patients who receive surgery, but a complication rate of 30% in patients who receive surgery, compared with 8% in non-operatively treated patients. […] To reduce the risk of functional lengthening (in which the tendon heals in an elongated position causing long-term weakness), patients need to be placed in a plantarflexed cast, backslab or removable orthosis with a heel wedge to force the ankle into plantarflexion as early as possible. […] It has been shown that a removable orthosis such as a CAM boot results in more favourable outcomes when compared with casting.

• #30 Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series | Journal of Experimental Orthopaedics | Full Text

  https://jeo-esska.springeropen.com/articles/10.1186/s40634-022-00451-5

  The deficits in heel-rise height in patients treated for CATR might be related to tendon elongation, degenerative changes related to age and/or an injury left untreated for longer than four weeks. […] The greatest patient-reported limitations were related to activities including running and jumping. […] Acceptable heel-rise capacity and hopping ratio were not recovered and there was significant elongation of the repaired tendon compared with the healthy side.

• #31 Achilles Tendon Rupture – Orthopaedia: Foot & Ankle

  https://pressbooks.pub/frontlinefootandankle/chapter/achilles-tendon-rupture/

  With age the Achilles tends to lose flexibility and may develop areas of tendonosis (degenerative changes) that can serve to weaken the tendon. […] Acute pain in the vicinity of the Achilles tendon or weakness of plantar flexion should be considered a red flag for an Achilles tendon rupture, prompting the examiner to perform the Thompson test. […] If the ruptured tendon is ignored (or not correctly diagnosed) the tendon ends will retract, leading to failure of the calf muscle and a dysfunctional lower leg. […] Factors that are associated with a higher risk for Achilles rupture include age between 30-50, male sex, playing recreational sports (most typically soccer, basketball, and tennis), prior steroid injections, and taking fluoroquinolone antibiotics.

• #32 Achilles tendon rupture – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/achilles-tendon-rupture/

  More than 20% of acute Achilles tendon ruptures are missed and subsequently become chronic ruptures. […] Achilles tendon ruptures may be managed conservatively or surgically; there is no consensus on which treatment modality is optimal. […] Treatment decisions are based on patient factors (e.g., age, comorbidities) and made in consultation with orthopedics. […] Re-rupture: in 5% of individuals after surgical treatment and 10% of individuals after conservative treatment.

• #33 Achilles Tendon Rupture Treatment & Rehab

  https://onepointhealth.com.au/achilles-tendon-ruptures/

  The risk of Achilles re-rupture can vary depending on several factors, including the initial treatment and rehabilitation process, individual healing capabilities, and adherence to post-injury guidelines. Studies have shown that the risk of re-rupture can range from 5% to 30%, with some factors increasing the likelihood of recurrence.

• #34 Achilles Tendon Rupture: What Is It, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21703-achilles-tendon-rupture

  An Achilles tendon rupture is a full or partial tear of the Achilles tendon. This acute (sudden) injury occurs when the tendon stretches to its breaking point. It happens most frequently while playing sports. Tripping, falling or twisting your ankle can also cause an Achilles tear. […] Sudden movement that puts stress on the Achilles tendon can lead to a rupture. Typically, people tear the Achilles tendon while playing sports. The biggest culprits are sports with sudden stops, starts and pivots such as soccer, football, basketball, tennis or squash. Achilles tendon tears aren’t always a sports injury. You can tear your Achilles tendon by tripping, missing a step when going downstairs or accidentally stepping into a hole and twisting your ankle. Some medications including certain antibiotics and steroid injections in the area can weaken the Achilles tendon. This can put you at a higher risk for a tear. […] A torn Achilles tendon is a traumatic injury that requires medical attention. Without treatment, an Achilles tendon rupture may not heal properly. This can increase your risk of rupturing it again.

• #35 Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series | Journal of Experimental Orthopaedics | Full Text

  https://jeo-esska.springeropen.com/articles/10.1186/s40634-022-00451-5

  Patients surgically treated for Chronic Achilles tendon rupture (n=22, 14 males and 8 females, mean age 6115) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf muscle endurance test, counter movement jump, Hopping, ultrasound measurement of tendon length, Achilles Tendon Resting Angle, dorsi flexion range of motion and calf muscle circumference. […] At one year postoperatively, patients with chronic Achilles tendon rupture reported persistent limitations in subjective foot and ankle function. […] The injured Achilles tendon in patients with CATR had elongated, and the injured side had a smaller calf circumference than the healthy side one year after the surgical repair. […] The patients with CATR in the present study exhibited an elongation of the injured tendon compared with the healthy side.

Zobacz więcej