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...
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 ACTIVIT...
SURGICAL
APPROACH THROUGH MEDIAL
SIDE OF TENDON SHEATH
FOOT IN EQUINUS=RESTING
EQUINUS OF OPP ANKLE
EDGES APPROXIMATED-bun...
CHRONIC RUPTURE
• GASTRONEMIUS FASCIA
SUTURED TO DISTAL STUMP
• V-Y LENGTHENING OF
GASTRONEMIUS APONEUROSIS
• TRANSFER OF ...
COMPLICATIONS
• RERUPTURE
• PARTIAL RUPTURE
• NECROSIS
• SLOUGHING
• INFECTION
Tendo achilles injury
Tendo achilles injury
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Tendo achilles injury

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Tendo achilles injury

  1. 1. TENDO- ACHILLES INJURY
  2. 2. ANATOMY
  3. 3. ANATOMY
  4. 4. ANATOMY
  5. 5. MECHANISM • DIRECT BLOW • SUDDEN DORSIFLEXION OF ANKLE • ACCIDENTAL SLIPPAGE INTO WATER CLOSET HIGHLEVEL LOWLEVEL
  6. 6. • HIGH LEVEL INJURY FOOT DORSIFLEXED AT TIME OF SLIPPAGE INJURY 3-4cm ABOVE INSERTION HEAL WELL AFTER REPAIR
  7. 7. LOW LEVEL INJURY •TRIES TO TAKE OUT FOOT IN PLANTAR FLEXED POSITION • SLICING OF TENDON AT A LOWER LEVEL • POOR HEALING
  8. 8. CHRONIC • DUE TO GRADUAL WEAKENING OF TENDON • AGE>40 • INVOLVT IN ACTIVE ATHLETICS • H/O TENDINITIS • LOSS OF FLEXIBILITY OF TENDO ACHILLES
  9. 9. SYMPTOMS • SUDDEN PAIN • AUDIBLE SNAP • WEAK PLANTAR FLEXION • PROMINENCE OF ACHILLES TENDON LOST
  10. 10. SIGNS • TIPTOE STANDING-LAG • PALPABLE DEFECT • THOMPSON’S TEST • O BRIEN’S NEEDLE TEST
  11. 11. THOMPSON’S TEST
  12. 12. INVESTIGATIONS • PLAIN X-RAY-NO BONY INJURY • MRI • PHYSICAL EXAMN DIAGNOSTIC
  13. 13. TREATMENT SURGICAL ACTIVE INDIVIDUALS RERUPTURE INJURY>2 WEEKS RISK OF WOUND HEALING PROBLEMS
  14. 14. NONSURGICAL • SEDENTARY INDIVIDUALS • HIGH RISK SURGICAL PTS • INC RISK OF WOUND PROBLEMS • CHANCE OF RERUPTURE +
  15. 15. NONSURGICAL • GRAVITY EQUINUS CAST • BELOW KNEE CAST • APPLIED FOR 3 MONTHS • FOLLOWED BY SUPERVISED STRENGTHENING ACTIVITIES
  16. 16. SURGICAL APPROACH THROUGH MEDIAL SIDE OF TENDON SHEATH FOOT IN EQUINUS=RESTING EQUINUS OF OPP ANKLE EDGES APPROXIMATED-bunnel or kessler stitch PLANTARIS REINFORCE REPAIR
  17. 17. CHRONIC RUPTURE • GASTRONEMIUS FASCIA SUTURED TO DISTAL STUMP • V-Y LENGTHENING OF GASTRONEMIUS APONEUROSIS • TRANSFER OF FHL TENDON • REPAIR USING PERONEUS BREVIS
  18. 18. COMPLICATIONS • RERUPTURE • PARTIAL RUPTURE • NECROSIS • SLOUGHING • INFECTION
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