Achilles Tendon Injuries Requiring Surgical Treatment in the Pediatric and Adolescent Population: A Case Series

Abstract

Pediatric Achilles tendon injuries requiring surgical treatment are considered rare and have not been well described. A retrospective chart review was conducted from 2010 to 2020 to identify cases of acute Achilles tendon rupture or laceration that required surgical repair in individuals 19 years or younger. A total of 24 individuals with acute Achilles tendon ruptures (n = 8) and lacerations (n = 16) were identified. All spontaneous ruptures occurred in skeletally mature individuals during sports. One subject was on minocycline at the time of injury, while two had a body mass index (BMI) ≥ 99% for age. Another had a history of clubfoot surgery on the injured side. Patients with lacerations were younger (9.9 ± 3.3 vs 16.3 ± 1.6 years) and had lower BMI (17.3 ± 3.8 vs. 28.0 ± 9.4) than those with spontaneous ruptures. The majority of cases had good outcomes with no postoperative complications.

Achilles Tendon Injuries in the Pediatric Population

“…4,[12][13][14][15] To our knowledge, this is the largest case series of exclusively pediatric patients with Achilles injuries to date, with only 1 additional series (n = 24) currently available. 16 We found that all injuries in patients ≤ 12 years old were from direct trauma to the Achilles, either laceration of the tendon due to penetrating trauma or a blunt force to the heel. Conversely, all ruptures due to muscular contraction were observed in patients ≥ 14 years.…”

“…Although the presentation and treatment of closed ruptures, and to a lesser extent, lacerations, are well-documented in adults, the literature regarding these pediatric injuries is limited primarily to case reports and epidemiological studies that include some adolescent patients as part of a larger adult cohort 4,12–15 . To our knowledge, this is the largest case series of exclusively pediatric patients with Achilles injuries to date, with only 1 additional series (n=24) currently available 16 . We found that all injuries in patients ≤12 years old were from direct trauma to the Achilles, either laceration of the tendon due to penetrating trauma or a blunt force to the heel.…”

Delayed Achilles Tendon Rupture at 17 Years of Age After Treatment of Clubfoot with Ponseti Method

“…No similar case has been previously reported along with the pathological findings. Few studies have reported that history of clubfoot is a risk factor for Achilles tendon rupture 4,5 ; however, the rationale for the same is unclear.…”

“…Few studies have reported that history of clubfoot is a risk factor for Achilles tendon rupture 4,5 ; however, the rationale for the same is unclear. Intraoperative findings.…”

“…A chilles tendon rupture is a relatively common athletic injury in adults, most often occurring as a midsubstance tear in active middle-aged men during eccentric contraction 1,2 . However, the published literature related to Achilles tendon ruptures in the pediatric or adolescent populations is limited [3][4][5] and includes a small number of cases in children with a history of clubfoot. Moreover, only 2 reports have described Achilles tendon rupture in patients with a history of clubfoot and Achilles tenotomy 6,7 .…”