Article
How degenerative is the tendon in achilles tendon ruptures?
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Authors
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Henrik Bäcker
- Charite Berlin, Columbia University Medical Center, Berlin, Germany
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J. Turner Vosseller
- Columbia University Medical Center, New York, United States
| Published: | October 22, 2019 |
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Outline
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Objectives: The extent of tendinosis along the entire tendon in Achilles-tendon-ruptures (ATR) has not previously been assessed. MRIs of acute ATRs were evaluated to assess this extent, even in areas distant from the rupture.
Methods: Patients who had MRIs for an ATR were reviewed. Each tendon was divided into a proximal, middle and distal segment with the full tendon length defined as the length measured from the myotendinous junction to the insertion. The site of tendon rupture, presence of tendinosis and/or additional tearing and largest AP diameter in the remaining segments were noted. In total, 45 MRIs were included in our study.
Results and conclusion: The mean total tendon length was 9.93cm, while the length from the insertion to the tear was 5.86cm. Of the 45 ruptures, 20 (44.4%) were in the proximal-third, 19 (42.2%) in the middle-third, and 6 (13.3%) in the distal-third. In all remaining segments where no ruptured tendon was observed, tendinosis was seen. Further, of the 90-thirds of a tendon without rupture, 87 had an AP diameter greater than 6mm (87/90, 96.7%). Of those 90 segments without rupture, 24 had a secondary partial-thickness tear in another third (24/90, 26.7%).
Tendinosis is a known precursor of an ATR; in the current study it was not limited to the area of rupture. The entire tendon degeneration may have implications for the optimal surgical treatment. In those patients that have surgery, it may be best to minimize suture fixation in tendon and rely on other means of restoring tension.
