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Sports medicine and sports injuries
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Tendon rupture classically occurs in middle-aged squash and badminton players. Simmonds or Thompson test is usually diagnostic (see Chapter 31). If there is the classic history of a feeling of a ‘kick to the calf ‘ and Simmonds test is negative, then ultrasound or MRI examination is mandatory as the Achilles rupture may be masked by the presence of a plantaris tendon. The Achilles tendon (see Chapter 36) can be allowed to heal in plaster with the foot plantar flexed to bring the tendon ends into contact. This takes several months. Alternatively, a surgical repair can be attempted. This opposes the ends and so should speed return to function, but risks compromising the blood supply to the tendon ends and so delays healing if the incision for access is large. In small-incision surgery, the risks are markedly reduced.
Foot and ankle disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
Examination: A gap is palpable at the site of rupture (usually about 4 cm proximal to the insertion of Achilles). However, this becomes difficult with a delayed presentation. The most reliable clinical test is the calf squeeze test (also known as the Simmonds or Thompson test). This test has very high sensitivity and specificity. The second test to aid the diagnosis is the single heel raise test. If there is plantar flexion of the foot on calf squeeze and the patient is able to perform a single heel raise, Achilles rupture is highly unlikely (Figure 8.3). One other clinical finding seen in cases of an old Achilles rupture is excessive dorsiflexion of the ankle on the ruptured side.
Higher Rate of Postoperative Complications in Delayed Achilles Tendon Repair Compared to Early Achilles Tendon Repair: A Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Shu-Kun He, Jing-Ping Liao, Fu-Guo Huang
The cause of Achilles tendon ruptures remains unclear, but risk factors include higher age (> 60 years), higher weight, present of inflammatory disorders and history of oral quinolone or corticosteroid use.19 An acute Achilles tendon rupture is often described as getting hit in the area of the ankle and the pain may be not severe. Thus, patients may not go to hospital immediately, and after several weeks or months, significant alteration in gait and continued functional impairment cause the patient to pursue treatment. Achilles tendon ruptures are commonly diagnosed with injury history and physical examination (such as a palpable gap). The Thompson test could assist in diagnosis, however, it is not reliable in chronic ruptures.20 Other tests, including the Matles knee flexion test21, the O’Brien needle test22 and the Copeland sphygmomanometer test23, also provide useful information about diagnosis. Maffulli et al24 evaluated the sensitivity and specificity of all mentioned tests, and they found that the Thompson test and the Matles test were more sensitive than the other tests. Radiography, ultrasonography and magnetic resonance imaging (MRI) are useful in the diagnosis of chronic Achilles tendon ruptures. A loss in definition of the Kager triangle could be seen in a lateral ankle radiograph when patients have suspected chronic Achilles ruptures.25 Ultrasonography is a cost-effective approach and allows dynamic imaging, however, its sensitivity is highly operator dependent.26 MRI provides more detailed information on the ruptured tendon and surrounding structures, and it is also useful for detecting partial ruptures.27
Interest of platelet rich plasma in Achilles tendon rupture management: a systematic review
Published in The Physician and Sportsmedicine, 2022
Pauline Daley, Pierre Menu, Bastien Louguet, Vincent Crenn, Marc Dauty, Alban Fouasson-Chailloux
Diagnosis can easily be made on clinical findings with a palpable gap and a positive Thompson test. Yet, some authors proposed a systematic imaging assessment with MRI or ultrasound to confirm the diagnosis [18,25,27].