Dynamic Ultrasound as a Selection Tool for Reducing Achilles Tendon Reruptures

Abstract

Reduction of rerupture and surgery risks may be possible using dynamic ultrasound case selection. Further studies are needed to show whether functional results are the same with surgical and nonsurgical treatment when dynamic ultrasound criteria are used for case selection.

Acute Achilles tendon rupture

“…Successful non-operative treatment relies on apposition of the ruptured tendon ends, which can be assessed during ultrasound in equinus and dorsiflexion. Kotnis et al (2006) successfully used dynamic ultrasound case selection of 125 patients; 58 patients with tendon gaps <5 mm in equinus were treated nonoperatively and 67 with gaps greater than 5 mm treated operatively. The authors concluded that patients with demonstrable apposition of ruptured ends will have similar re-rupture rates treated conservatively to those managed operatively.…”

Acute Achilles Tendon Rupture

“…In some series on nonoperative AT rupture, treatment measuring tendon gap adaptation in plantar flexion by ultrasound is claimed to reduce rerupture risk; only patients without tendon gap in plantar flexion are considered for nonoperative therapy. 6,10 But there is no proper randomized trial on surgical versus nonoperative treatment in patients with AT rupture with no tendon gap at ultrasound investigation. For those without rerupture, functional bracing appears to produce good results according to Leppilahti outcome scores.…”

The role of ultrasound imaging in acute rupture of the Achilles tendon

“…Ultrasound examination of the Achilles tendon is performed using a high-frequency linear transducer (7)(8)(9)(10)(11)(12)(13). The tendon may be conveniently examined in the prone position with the foot over the end of the examination couch.…”