ACHILLES TENDON

RUPTURE

ANATOMY

Achilles tendon formed by the

Gastrocnemius and Soleus musculature
Strongest and thickest tendon in the
human body
Commonly torn 2 to 6 cm proximal to
insertion
Commonly torn
Common MOI:
o Pushing off weight bearing foot with
knee extended
o Sudden DF of ankle
o Forceful DF of PF foot

Maquirriain J. Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation. The Yale
Journal of Biology and Medicine 2011;84(3):289-300.
Jzsa L, Kvist M, Blint BJ, et al: The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical,
and sociological study of 292 cases. Am J Sports Med. ,1989;17: 338 343.

ROLE OF IMAGING
Diagnosis/assessment
o Staging and severity of the injury
o Evaluation of integrity after surgery or
conservative treatment
Illustrates tendon thickening and
intrasubstance imaging uniformity
o Integrity of structures
Tendon, surrounding soft tissue, bony
structures
Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54.

GOLD STANDARD?
No true gold standard for diagnosis via imaging
Systematic reviews fail to identify recommendation of
consistent use of MRI, ultrasound, or radiograph
+ Thompson test gold standard for physical evaluation
(Sensitivity=.96; Specificity=.93)
More research is needed

The diagnosis and treatment of acute achilles tendon rupture. Rosemont, IL: American Academy of Orthopedic Surgeons; 2009.
Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 1998;26(2):266-270.

MRI
Theoretically best option for
determining rupture
Use T1 and T2 combined
Confirmation:
o Complete disruption of tendon
fibers in full tear
o Thickened tendon in partial tears
(normal=6 mm A/P)
o + Arners sign
o + Kagers triangle
o Toygars angle less than 150
degrees
Cetti, R and Anderson, I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Ortho Relat Res. 1993;286:215-221.
Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54.
Ly, J and Bui-Mansfield, L. Anatomy and abnormalities associated with kagers fat pad. American Journal of Roentgenology.
2004;182: 147-154.

T1

T2

ULTRASOUND
Benefits
Cost friendly
Widely available
equipment
Ease of contralateral
comparison
Ability to see image during
joint motion
Hartgerink P, Fessell DP, Jacobson JA, Van Holsbeeck MT. Full- versus partial-thickness achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation.
Radiological Society of North America. 2001; 220(2).

Findings

Dong Q and Fessell DP. Achilles tendon ultrasound technique. American Journal of Roentgenology. 2009; 193(3): W173

RADIOGRAPH

Provides limited soft tissue information

Lateral radiographs can still provide

information on Achilles
tendon and adjacent structures.

Soft tissue swelling and edema may

be present on a plain film radiograph

Abnormalities of Kagers fat pad are

common in Achilles tendon ruptures

Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and

pathologic conditions of ankle tendons: Current imaging techniques.
Radiographics 1992; 12:429444.

ROLE OF IMAGING IN
MANAGEMENT

Ultrasound and MRIs are used following successful

intervention to monitor the Achilles tendon.

Abnormalities may show up on images.

Once healed, the torn Achilles tendon will continue to

appear thickened and irregular.

Calcifications may also occur at a site of a prior tear.

Post op MRI may show a tendon gap though this tends

to resolve in 12 weeks.

Hollenberg GM, Adams MJ, Weinberg EP. Sonographic appearance of nonoperatively treated Achilles tendon ruptures. Skeletal Radiol 2000; 29:259264.
Fujikawa A, Kyoto Y, Kawaguchi M et-al. Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing. AJR Am J Roentgenol. 2007;189 (5): 1169-74.

BIOMECHANICAL AND PHYSICAL

IMPAIRMENTS
Pain, swelling near the heel and
calf
Palpable defect at the normal
insertion of tendon on calcaneus
Decreased/inability to ambulate
and full weight bear on affected
extremity
Decreased plantar flexion strength
Increased passive dorsiflexion (+

Stickles SP, Friedman L, Demarest M, Raio C. Achilles tendon rupture. Western Journal of Emergency Medicine. 2015; 16(1): 161162.
Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med
1998;26(2):266-270.
Hess GW. Achilles tendon rupture. Foot Ankle Spec. 2010; 3(1): 29-32

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 Thank

You!

REFERENCES
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Jzsa L, Kvist M, Blint BJ, et al: The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and
sociological study of 292 cases. Am J Sports Med. ,1989;17: 338 343.
Maquirriain J. Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation. The Yale Journal of
Biology and Medicine 2011;84(3):289-300.
The diagnosis and treatment of acute achilles tendon rupture. Rosemont, IL: American Academy of Orthopedic Surgeons; 2009.
Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and pathologic conditions of ankle tendons: Current imaging
techniques. Radiographics 1992; 12:429444.
Hollenberg GM, Adams MJ, Weinberg EP. Sonographic appearance of nonoperatively treated Achilles tendon ruptures. Skeletal Radiol
2000; 29:259264.
Fujikawa A, Kyoto Y, Kawaguchi M et-al. Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated
healing. AJR Am J Roentgenol. 2007;189 (5): 1169-74.
Dong Q and Fessell DP. Achilles tendon ultrasound technique. American Journal of Roentgenology. 2009; 193(3): W173
Hartgerink P, Fessell DP, Jacobson JA, Van Holsbeeck MT. Full- versus partial-thickness achilles tendon tears: sonographic accuracy
and characterization in 26 cases with surgical correlation. Radiological Society of North America. 2001; 220(2).
Stickles SP, Friedman L, Demarest M, Raio C. Achilles tendon rupture. Western Journal of Emergency Medicine. 2015; 16(1): 161162.
Bleakney RR, White LM. Imaging of the achilles tendon. Foot and Ankle Clinics of North America. 2005; 10(2):239-54.
Ly, J and Bui-Mansfield, L. Anatomy and abnormalities associated with kagers fat pad. American Journal of Roentgenology.
2004;182: 147-154.
Cetti, R and Anderson, I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Ortho Relat Res. 1993;286:215-221.
Hess GW. Achilles tendon rupture. Foot Ankle Spec. 2010; 3(1): 29-32