Håkan Alfredson1, Lorenzo Masci, Lars Ohberg. 1. Department of Surgical and Perioperative Science Sports Medicine, University of Umeå, Sweden. hakan.alfredson@idrott.umu.se
Abstract
BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain and/or relative weakness in plantar flexion force is an indicator. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: The aim of this study was to evaluate the ultrasound (US) and colour Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. MATERIALS AND METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71 years) were examined clinically and by US+CD because of mid-portion Achilles tendon pain. There was an acute onset in 14 of 17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients, the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the US findings showing disruption on the dorsal side and a partial rupture in the dorsal and mid-tendon. CONCLUSIONS: US and Doppler examination can be helpful tools to diagnose partial mid-portion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line and high blood flow in the structurally abnormal dorsal tendon indicate a partial rupture.
BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain and/or relative weakness in plantar flexion force is an indicator. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: The aim of this study was to evaluate the ultrasound (US) and colour Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. MATERIALS AND METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71 years) were examined clinically and by US+CD because of mid-portion Achilles tendon pain. There was an acute onset in 14 of 17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients, the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the US findings showing disruption on the dorsal side and a partial rupture in the dorsal and mid-tendon. CONCLUSIONS: US and Doppler examination can be helpful tools to diagnose partial mid-portion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line and high blood flow in the structurally abnormal dorsal tendon indicate a partial rupture.
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