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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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