3 years ago
11
1
Posted On: April 4th 2024, 01:14 pm
Let’s talk about achilles tendon ruptures and management!
There is an ongoing debate regarding the use of conservative vs surgical management with regard to mid portion tendon rupture. To be frank - it seems like it’s mostly based on the wish of the patient and the general preference of the surgeon rather than thorough examination and rational decision making. I see many patients whom have been hastily clinically examined in the ER and treated conservatively with very different outcomes.
Ultrasound is great and easily accessible diagnostic tool that can be used to help decide between conservative and surgical treatment. Diastasis of the tendon ends is of great importance hence this seems to heavily influence the risk for re-ruptures and poorer long term outcomes. Research suggests a cut of around 5-10 mm with a highly elevated risk of re-ruptures in distasis greater than 10 mm.
I´ve seen a lot of patients with re-ruptures and elongated tendons due to inaccurate management. Re-ruptures can have catastrophic effects and should be avoided at all costs.
There are also a fairly large number of patients with a mid portion achilles rupture whom has been wrongfully diagnosed as having a partial tear of even a calf muscle rupture.
Maybe it’s time to stop guessing when it comes to diagnosis and management of achilles tendon rupture? Picture 1 show a patient with a large distasis where surgery had a good outcome. Picture 2 show a enormous distasis with proximal tendon retraction after failed conservative treatment. Probably due to an undetected large diastasis at the initial clinical examination. #achilles #achillesrupture #achillestendon #tendon #injury #injurymanagement #sportsinjuries #ultrasound #ultrasoundscan #surgery #orthopedicsurgeon
There is an ongoing debate regarding the use of conservative vs surgical management with regard to mid portion tendon rupture. To be frank - it seems like it’s mostly based on the wish of the patient and the general preference of the surgeon rather than thorough examination and rational decision making. I see many patients whom have been hastily clinically examined in the ER and treated conservatively with very different outcomes.
Ultrasound is great and easily accessible diagnostic tool that can be used to help decide between conservative and surgical treatment. Diastasis of the tendon ends is of great importance hence this seems to heavily influence the risk for re-ruptures and poorer long term outcomes. Research suggests a cut of around 5-10 mm with a highly elevated risk of re-ruptures in distasis greater than 10 mm.
I´ve seen a lot of patients with re-ruptures and elongated tendons due to inaccurate management. Re-ruptures can have catastrophic effects and should be avoided at all costs.
There are also a fairly large number of patients with a mid portion achilles rupture whom has been wrongfully diagnosed as having a partial tear of even a calf muscle rupture.
Maybe it’s time to stop guessing when it comes to diagnosis and management of achilles tendon rupture? Picture 1 show a patient with a large distasis where surgery had a good outcome. Picture 2 show a enormous distasis with proximal tendon retraction after failed conservative treatment. Probably due to an undetected large diastasis at the initial clinical examination. #achilles #achillesrupture #achillestendon #tendon #injury #injurymanagement #sportsinjuries #ultrasound #ultrasoundscan #surgery #orthopedicsurgeon
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