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Neglected Achilles tendon rupture with central insertional plantaris tendon hypertrophy: two cases.

Boer R, Swierstra BA, Verheyen CC - Strategies Trauma Limb Reconstr (2009)

Bottom Line: In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found.A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation.It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.

View Article: PubMed Central - PubMed

Affiliation: Isala Clinics, De Weezenlanden Hospital, Groot Wezenland 20, Zwolle, The Netherlands, ronaldboer@btinternet.com.

ABSTRACT
A neglected Achilles tendon rupture is often characterized by muscle weakness and an overlengthened repair by scar tissue. Reconstructive surgery is usually performed taking into account the patient's required level of function. Two surgical cases of neglected Achilles tendon rupture are presented in this article. In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found. However, after longitudinal opening of the tendons, a thickened plantaris tendon was evident at the insertion on the calcaneus in both cases. This hypertrophic tendon occupied most of the diameter of the Achilles tendon. Due to partial or complete rupture of the Achilles tendon, there was notable weakening and tendon transfer-augmentation was performed. A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation. It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.

No MeSH data available.


Related in: MedlinePlus

Perioperative findings in Case 2: A Thickened plantaris tendon; B Degenerative Achilles tendon; C Normal plantaris tendon
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Related In: Results  -  Collection


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Fig3: Perioperative findings in Case 2: A Thickened plantaris tendon; B Degenerative Achilles tendon; C Normal plantaris tendon

Mentions: A 53-year-old man presented with a longstanding history of Achilles tendinopathy, which had been treated conservatively, including one steroid injection. One year prior to presentation, he had experienced acute pain around his left Achilles tendon, with impaired function, while playing tennis. He could no longer run and had difficulty walking up and down stairs. He also complained of morning stiffness and pain. On examination, there was atrophy of the calf muscle; toe walking was not possible and dorsiflexion was increased on the left side. A neglected Achilles tendon rupture was suspected, and confirmed by ultrasound. Fibrosis bridging the tendon gap and tendinosis in the remaining tendon was also found. Hypertrophy of the plantaris tendon was not detailed in the radiology report. Operative reconstruction with augmentation graft was suggested and planned. After opening the Achilles tendon in a longitudinal manner, a hypertrophic plantaris tendon was clearly visible, which had no obvious cross-links with the remaining Achilles tendon (Fig. 3). Reconstruction by transfer-augmentation followed using the flexor digitorum tendon.Fig. 3


Neglected Achilles tendon rupture with central insertional plantaris tendon hypertrophy: two cases.

Boer R, Swierstra BA, Verheyen CC - Strategies Trauma Limb Reconstr (2009)

Perioperative findings in Case 2: A Thickened plantaris tendon; B Degenerative Achilles tendon; C Normal plantaris tendon
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666823&req=5

Fig3: Perioperative findings in Case 2: A Thickened plantaris tendon; B Degenerative Achilles tendon; C Normal plantaris tendon
Mentions: A 53-year-old man presented with a longstanding history of Achilles tendinopathy, which had been treated conservatively, including one steroid injection. One year prior to presentation, he had experienced acute pain around his left Achilles tendon, with impaired function, while playing tennis. He could no longer run and had difficulty walking up and down stairs. He also complained of morning stiffness and pain. On examination, there was atrophy of the calf muscle; toe walking was not possible and dorsiflexion was increased on the left side. A neglected Achilles tendon rupture was suspected, and confirmed by ultrasound. Fibrosis bridging the tendon gap and tendinosis in the remaining tendon was also found. Hypertrophy of the plantaris tendon was not detailed in the radiology report. Operative reconstruction with augmentation graft was suggested and planned. After opening the Achilles tendon in a longitudinal manner, a hypertrophic plantaris tendon was clearly visible, which had no obvious cross-links with the remaining Achilles tendon (Fig. 3). Reconstruction by transfer-augmentation followed using the flexor digitorum tendon.Fig. 3

Bottom Line: In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found.A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation.It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.

View Article: PubMed Central - PubMed

Affiliation: Isala Clinics, De Weezenlanden Hospital, Groot Wezenland 20, Zwolle, The Netherlands, ronaldboer@btinternet.com.

ABSTRACT
A neglected Achilles tendon rupture is often characterized by muscle weakness and an overlengthened repair by scar tissue. Reconstructive surgery is usually performed taking into account the patient's required level of function. Two surgical cases of neglected Achilles tendon rupture are presented in this article. In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found. However, after longitudinal opening of the tendons, a thickened plantaris tendon was evident at the insertion on the calcaneus in both cases. This hypertrophic tendon occupied most of the diameter of the Achilles tendon. Due to partial or complete rupture of the Achilles tendon, there was notable weakening and tendon transfer-augmentation was performed. A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation. It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.

No MeSH data available.


Related in: MedlinePlus