Achilles Tendon Trauma

Question 1

Where do most Achilles ruptures occur? why?

Answer 1

2-6cm from the insertion (this is the watershed area/ zone of hypovascularity as well as the point of maximal twist in the fibers of achilels tendon)

Question 2

Where do most Achilles ruptures occur? why?

Answer 2

2-6cm from the insertion (this is the watershed area/ zone of hypovascularity as well as the point of maximal twist in the fibers of achilels tendon)

Question 3

Describe the fibers of the Achilles tendon.

Answer 3

rotate from medial to lateral in a spiral fashion. The maximal twist is reached about 2-6cm from the insertion.

Question 4

What are the mechanisms of indirect trauma to the Achilles tendon?

Answer 4

1. pushing off a WB forefoot and extended knee
2. sudden dorsiflexion of the ankle (as in slipping on a stair)
3. violent dorsiflexion of a plantarflexed foot (fall from height)

Question 5

what are some mechanisms of direct trauma to the Achilels tendon?

Answer 5

laceration with glass
gunshot wounds
direct blow by an object

Question 6

What is the “hatchet strike defect”?

Answer 6

palpable gap/dell in the posterior ankle

Question 7

what is the Thompson squeeze test?

Answer 7

(patient prone, flexing the leg)

perform side-to-side compression of the calf; if the tendon is ruptured, there will be no platnarflexion visualized

Question 8

What is Mattles test?

Answer 8

(patient prone, knee and leg flexed at 90 deg)
if the achilles tendon is ruptured, teh foot will be visualized resting at 90 deg or less. The nonaffected foot will be slightly plantarflexed due to intact Achilles tendon

Question 9

explain the needle exam.

Answer 9

(patient prone, place needle in the triceps-surae muscle belly above perceived rupture site) With the needle in place, plantarflexion of foot is performed.if the achilles is intact, the needle will move upon plntarflexion of the foot.

Question 10

what are teh 3 types of suture techniques for open repair of achilles tendon?

Answer 10

Bunnell
Kessler
Krackow

Question 11

Describe the fibers of the Achilles tendon.

Answer 11

rotate from medial to lateral in a spiral fashion. The maximal twist is reached about 2-6cm from the insertion.

Question 12

What are the mechanisms of indirect trauma to the Achilles tendon?

Answer 12

1. pushing off a WB forefoot and extended knee
2. sudden dorsiflexion of the ankle (as in slipping on a stair)
3. violent dorsiflexion of a plantarflexed foot (fall from height)

Question 13

What is the “hatchet strike defect”?

Answer 13

palpable gap/dell in the posterior ankle

Question 14

what is the ideal repair time for achilles tendon rupture? why?

Answer 14

within the first 7-14 days because that is when the greatest amount of vascularity to the injured site occurs. after that, the injury is no longer in the inflammatory stage of healing and the vascularity to the injury decreases

Question 15

What surrounds tendon?

Answer 15

epitenon

Question 16

What is peritenon? (mesotenon)

Answer 16

epitenon + paratenon

Question 17

Where are tendon sheaths found?

Answer 17

found where tendons change course/direction

Question 18

Where is paratenon found?

Answer 18

on tendons with a straight pull (ie. Achiles)

Question 19

What are the sources of vascular supply to the tendon?

Answer 19

1. musculotendinous junction
2. bone/periosteum interface
3. paratenon

Question 20

What is the name for the most distal end of collagen fibers of the Achilles tendon that inserts into the calcaneus?

Answer 20

Sharpey’s fibers

Question 21

What are the phases of tendon healing?

Answer 21

inflammatory
proliferative
remodeling

Question 22

describe the time course for each phase of tendon healing.

Answer 22

inflammatory (48-72 hrs)
proliferative ( day 5)
remodeling (15-28 days)

Question 23

when is the gap bridged after an achilles tendon rupture?

Answer 23

week 2

Question 24

when can a patient return to high impact sports after a tendon injury?

Answer 24

month 4- larger collagen bundle formation occurs

Question 25

what what percentage of resting length does muscle produce the greatest force?

Answer 25

120%

Question 26

what is a tendon transposition?

Answer 26

re-routing the tendon without detaching it

Question 27

what is a tendon suspension?

Answer 27

using a tendon to give support to a structure

Question 28

What is the Krakow stitch favorable for tendon repair?

Answer 28

the suture doesn’t go right thru the tendon like the others do (so does not constrict vascular supply to tendon like some of the other ones do)

Question 29

what tendon transfer could you do for a ruptured Achilles?

Answer 29

FHL transfer - used to restore plantarflexion of the ankle

plantaris

Question 30

Where is the surgical incision preferred for open repair of Achilles tendon, and why?

Answer 30

longitudinal incision made medial to the tendon is preferred because of avoidance of sural nerve injury or lesser saphenous vein plexus

Question 31

What is Toygar’s angle?

Answer 31

measured along the line of the posterior skin surface on the radiograph where the Achilles tendon courses posteriorly as it approaches its insertion site on the calcaneous. This angle is normally greater than 150° but may decrease below that threshold in the setting of Achilles tendon rupture.