ACHILLES TENDON

RUPTURE
ETIOLOGY
Common in middle-aged athletes

The mechanisms : pushing of with the

weight bearing forefoot while extending
the knee, sudden unexpected
dorsiflexion of the ankle, and violent
dorsiflexion of the plantar flexed foot as
in a fall from a height
PATHOPHYSIOLOGY
Related to a relatively hypovascular area of the
tendon

With increasing age :

Reduced mesenteric supply

The cause of tendon achilles rupture probably is a

combination of a relatively hypovascular area and
repetitive microtrauma that cause an inflammatory
reparative process, which, because of decreased
vascularity, is unable to keep up with the stresses
DIAGNOSIS :

HISTORY TAKING
PHYSICAL EXAMINATION
RADIOGRAPHI EVALUATION
PHYSICAL EXAMINATION

LOOK
FEEL
MOVE
SPESIAL TEST
 PHYSICAL EXAMINATION
LOOK (inspection)

FEEL (palpation)
PHYSICAL EXAMINATION

MOVE
- PAIN AT THE BEHIND OF THE ANKLE
- DIFFICULTY IN PLANTAR FLEXION
PHYSICAL EXAMINATION

SPECIAL TEST
1. THOMSON TEST
2. OBRIEN TEST
DIAGNOSIS
Thomson test : normally when the calf is
squeezed the foot move as the ankle
plantarflexes
OBriens needle test : a 25-gauge needle is
placed percutaneously in midline of the
proximal tendon. Motion of the proximal
tendon indicating continuity is detected by
observing the needle when the foot is put
through passive range of motion
.
PEMERIKSAAN PENUNJANG

1. USG
2. MRI
Treatment :
1. conservative
2. operative
CONSERVATIVE

INDICATION:
elderly with minimal displace
LLC:
6 weeks SLC 4 weeks
SLC:
6-8 weeks with GRAVITY EQUINES
OPERATIVE

The most appropriate is surgery

Reason :
- preferred when treating younger and
more athletic patiens
- contracture gastrocnemius
- gap
OPERATIVE

BUNNELL
KESSLER
TECHNIQUE
the patient in the prone position
posteromedial longitudinal incision make it
about 1 cm medial to the tendon
TECHNIQUE
Approximate the ruptured ends of the tendon
with 2-0 nonabsorbable tension suture
using a modified Kessler stitch.
TECHNIQUE
Apply a short leg cast with the foot in gravity
equinus.
AFTERTREATMENT
At 2 weeks the cast is removed, the staples
or sutures are removed. Another short leg
cast with the foot in gravity equinus is worn
for an additional 2 weeks.
At 4 weeks the cast changed, and the foot is
gradually brought to the plantigrade position
over the next 2 weeks. Walking is gradually
resumed with partial weight bearing on
crutches during a 2-week period.
TERIMA KASIH