Achilles tendon rupture

Achilles-tendon The Achilles tendon rupture (ASR) is the rupture of the Achilles tendon. They usually only occurs on predamages by excess and stress. A rupture can be treated surgically or with a firm bandage or conservative treatment.

Anatomical-Physiological Basis

The Achilles Tendon - Tendo calcaneus (Achilles) - is supposedly the strongest tendon in the human body. She sits at the calcaneal tubercle (tuberosity of the calcaneus) and united as a tendon of the calf muscle (triceps surae), the terminal tendons of the three calf muscles.


She's grown loads of 60-100 N / mm ², equivalent to 80 mm ² a carrying capacity of up to 800 kilograms. A sudden rupture of the Achilles tendon strain of the triceps surae therefore usually occurs only when predamages by an over-and stress. The tendon undergoes again and again minor injuries that disrupt the blood supply to the tissues and thus lead to the degeneration of the tissue .These changes are affecting the most in the range 2-6 cm above the insertion of (so-called "Achilles waist"), where the tendon is supplied at the worst, and is also where most of the crack .The tendon then breaks suddenly with a loud noise peitschenknallähnlichen. The plantar is then only a very limited extent. In the Achilles tendon (Achilles tendon) is usually a sudden transection of the Achilles tendon. Rarely occurs with notice of the Achilles tendon, such as Achilles tendon pain or irritation. Consequently, physically active people are often disproportionately affected by an Achilles tendon injury. It shows a cluster of physically active men aged 30 to 50 years. A rare cause is taking a different antibiotic, the group of gyrase inhibitors, levofloxacin, for example. The elderly and patients taking corticosteroids, are at greater risk.

Diagnosis

Clinically, there is usually a palpable gap), most commonly a few centimeters above the insertion of the heel bone (calcaneus). Occasionally, the area is swollen and bloodshot. Walking on tiptoe is not possible anymore. With complete rupture of the Thompson test is positive, the patient lies on his stomach, his feet hanging over. Now, if the calf muscle of both sides pressed together, so it usually comes to plantar flexion, but not in an Achilles tendon rupture. In the ultrasound, the distance between the two tendons can be determined, and whether a complete or partial rupture.

Treatment

In principle, this can be done conservatively or surgically with a crack.

Treatment without surgery (conservative)

The foot is immobilized by a firm bandage (eg plaster, special shoe orthosis). The healing progress will be monitored (eg ultrasound). The foot is immobilized only here for about 1 week in 20 ° equinus. This is followed by the supply with a special shoe with a heel lift for approximately 6 weeks. A conservative method is especially useful in patients at increased surgical risk.

Surgical treatment

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Both open surgery and minimally invasive surgery to be performed in either local anesthesia, regional anesthesia or general anesthesia (general anesthesia). By a tourniquet on the thigh, the blood supply for the duration of the surgery can be prevented (tourniquet) to reduce blood loss and improve the data in the operational area.
  • Open surgery: The cracked and auseinandergewichenen tendon are exposed and a suture and / or gluing reunited. In old tendon tear or heavy wear on the skin or muscle tendon must sometimes part of Nachbarsehnen structures to reinforce the Achilles tendon and Achilles tendon to bridge used to be broken) (tendon with a plastic interposition). In the rare bony avulsion of the tendon directly from the heel bone, the bone piece is screwed together with the re-attached tendon calcaneal tuberosity.
  • Minimally invasive surgery: In contrast to open surgery does not expose the surgical field, but the torn tendon ends are sought through small skin incisions and back together again. A small cross section at the level of the rupture to allow for an approximation of the torn tendon to
Depending on the operative findings, the insertion may be a wound drainage tube for the suction of wound exudate and blood is required.
Even after surgical treatment or care is immobilization of the leg for several weeks is required. The foot is to relieve the early tendon fixed in equinus (about 30 ° to 40 °) and then returned slowly over weeks into its normal position. Close monitoring by a physician weiterbehandelnden are required.

Rehabilitation

The tendon is restrained by both approaches usually in a leg cast for 6 weeks or in a special boot (industrial-made orthotics from different manufacturers). Subsequently a gradual phased rehabilitation program. During this time the foot is in equinus (held approximately 10 ° to 20 °), which can be gradually reduced after each treatment. Especially in the to 10 Week is the danger of another crack high. Loose jogging on level ground can usually be started after about 4 to 6 months. The Achilles tendon healed achieved - as all the other torn tendons, too never recover full load capacity. It lies at an optimal course of about 80 to 90% of the healthy tendon. Nevertheless, in the best case will again be fully sports - including competitive sport – run.

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