Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions

Abstract

Level IV, retrospective case series.

Repair of Achilles sleeve avulsion: a new transosseous suture technique

“…All 11 patients in our series met the criterion of being overweight or obese. Similar findings were reported by Huh [12]. To reduce the risk of Achilles sleeve avulsion, we suggest weight loss and health education for overweight patients who have presented tendinopathy symptoms.…”

“…According to unpublished data from our institution collected over the previous 5 years, Achilles sleeve avulsion only constituted 2.6% of all Achilles tendon ruptures. A previous study reported that Achilles sleeve avulsion typically arose from insertional Achilles tendinopathy [11,12]. We also observed a high prevalence (11 of 11 cases) of pre-existing insertional Achilles tendinopathy in our series.…”

“…In this study, we found that all ruptures occurred at the middle part of the calcific spur, leaving a spur base at the calcaneus. Similar radiological features have been observed in other studies [12][13][14]22]. Because the calcific spur is part of the usually painful problem of Achilles tendinopathy, we removed degenerative tissue together with the main body of the calcified spur and only preserved an approximately 5-mm-flat base at the insertional site as the stump for the bone tunnels.…”

“…Compared with the more common Achilles rupture, Achilles sleeve avulsion is much rarer. A previous study reported that 7.6% of all operatively managed Achilles ruptures were distal ruptures [12]. According to unpublished data from our institution collected over the previous 5 years, Achilles sleeve avulsion only constituted 2.6% of all Achilles tendon ruptures.…”

“…Open reduction and screw fixation, usually used to fix large bone fragment, cannot effectively resist the pull-out tension of the triceps surae [10]; Achilles sleeve avulsion fixation has no existing standard operative operation. The current operative technique includes suture and anchor, transcalcaneal suture, or some combination of both [11][12][13][14][15][16]. Although good to excellent outcomes have been reported, these techniques have drawbacks such as high-cost foreign material implantation and infection risk in the case of the suture anchor technique [13,15] and technically demanding operation and extensive iatrogenic injury in the case of the transcalcaneal suture technique [11,16].…”