The document provides an overview of tendoachilles injuries, including classification into ruptures and tears, their mechanisms, clinical features, diagnosis, and treatment methods. It outlines examination techniques, surgical repair procedures for both fresh and neglected ruptures, and post-operative management strategies. Key examinations and surgical techniques are detailed, along with indications for each method of treatment.

1. TendoAchilles rupture
Dr. Md. Ashiqur Rahman
Resident
Orthopedics
DMCH

2. Questions
1. What is the problem?
2. Duration?
3. Any H/O trauma?
4. What were you doing during trauma?
5. Any H/O injection in the ankle?
6. Do you take any medicine regularly?

3. Exposure : Both lower limb upto ankle
On examination:
Look:
1. Any scar mark, skin change, skin change, blackening behind the
ankle.
2. Visible gap in TA.
3. Gait abnormalities.
4. Heel & toe walking.

4. Feel:
1. There is tenderness at the rupture site.
2. A gap felt 5cm above the insertion. This gap is more prominent with
dorsiflexion of ankle joint.
3. Thompson’s squeeze test/Simmond’s test: Positive
4. Matle’s test : Positive
5. O’brien’s test : Positive

6. O’Brien’s needle test

7. Matles’s test

8. Move:
1. Ankle movement : Plantar flexion is weak.
Tendoachilles injury can be classified can be classified into 02
categories:
1. Tendoachilles rupture: Due to degenerative cause : Steroid injection,
spontaneous.
2. Tendoachilles tear: Due to trauma : Direct blow. Cut injury,
commode injury.

9. Mechanism
A. Indirect :
• Pushing off with the weight bearing forefoot while extending the
knee.
• Sudden unexpected dorsiflexion of the ankle.
• Violent dorsiflexion of the plantar flexed foot, as in a fall from a
height.
B. Direct:
• Direct blow to the contracted tendon or from a laceration.

10. Site:
• Rupture of TA usually takes place about 2-6cm/5cm from the
insertion (Watershed line).

11. Clinical features
• Most patients are aged over 40 years.
• Feeling is has been stuck just above the heel.
• Unable to tip-toe & push-off.
• A gap can be seen and felt 2 to 5cm above the insertion of the
tendon.
• Simmond’d test/Thompson squeeze test, Mateles test, O’brien’s
needle test : Positive.
• Investigations: X-ray on ankle joint to exclude any fractures
USG
MRI

12. Precipitating factors
• Aging process
• Tendinitis
• Tendinosis
• Peritendinitis
• Local steroid injection
• DM
• Repetitive microtrauma

13. Principle of TA injury treatment
• Cut injury, traumatic injury & degenerative ruptures presented early
can be repaired end to end.
• All neglected ruptures need reconstruction by various techniques.

14. Various techniques of treatment of TA injury
A. Repair of fresh & early cases (Up to 4-6 weeks)
1. Krackow technique :
• Posteromedial incision
• Approximate the ruptured tendon done
with a 2.0 non absorbable suture.

15. 2. Lindholm technique:
• Posterior curvilinear incision
• Debridement of the ragged ends of
the tendon done.
• Approximated by box type of mattress
suture of heavy nonabsorb. Suture
• 02 flaps from the proximal tendon &
gastrocnemius aponeurosis taken &
sutured to the distal stump of the tendon
& to one another to cover the site of
rupture completely.

16. 3. Lynn technique:
• Incision parallel to the medial
border of TA.
• The ends of TA are sewed with 2.0
absorbable sutures.
• Then it is covered with by fanned
Out plantaris tendon.

17. 4. Teuffer technique :
• Postero-lateral longitudinal incision
• Reinforcement of TA is done by
passing the peroneus brevis tendon
through a drill hole in the calcaneal
tuberosity to produce a dynamic loop.

18. 5. Turco & spinella :
• Here the peroneus brevis is passed
through a midcoronal slit in the distal
stump of the TA.

19. 6. Ma & Griffith technique :
• Is a method of percutaneous repair
of TA using a nonabsorbable suture
threaded on a straight needle.

20. B. Reapair of neglected rupture (>4-6 weeks):
1. White & Kraynick modification of Teuffer technique:
• Postero-lateral incision.
• TA is repaired by harvested plantaris
tendon in figure of eight fashion.
• Reinforced by peroneus brevis tendon
by passing it through a drill hole in the
calcaneal tuberosity.

21. 2. Bosworth technique :
• Posterior longitudinal midline incision.
• A strip of tendon 1.5cm wide & 17.5cm
to 22.5cm long.
• Strip of tendon taken from the medial
raphe of the gastrocnemius muscle.
• The strip is passed through the proximal
& distal ends of the tendon in different
direction.

22. 3. Abraham & Pancovich (V-Y tendinous flap):
• A lazy ‘S’ incision.
• An inverted ‘V’ incision made through
the aponeurosis over the gastrocnemius.
• The flap is pulled distally to repair the
ruptured tendon ends & proximal part of
the incision is closed in a Y-configuration.

23. 4. Wapner et al. technique:
• Incision on the medial border of the
foot, the flexor hallucis longus tendon
is separated.
• Then the other incision is given postero-
medial to the TA.
• FHL tendon is passed through the tunnel
made in the calcaneus.
• Thereafter it is weaved from distal to
proximal through Achilles tendon.

24. Priciple of vulpius procedure:
• Equinous deformity due to gastrocnemius contracture is corrected by
this procedure.
• Aponeurotic tendon of the gastrocnemius is divided and its distal part
is allowed to retract distally but is not sutured to the soleus.

25. Post-operative management of ruptured TA
• Long leg full plaster with window or anterior slab with knee in 45°-60°
flexed & ankle in equinous position.
• Stitches are removed after 14 days.
• LLFP is converted to SLFP freeing the knee after 4-6 weeks.
• Plaster discarded after 8-10 weeks & walking with high heel shoe is
allowed.
• Heel heigh is reduced gradually & made planti-grade by next one
month.
• Protection of the tendon from stress is needed for at least 6 months.