MRI of the Achilles tendon – a comprehensive pictorial review. Part two

Abstract

Highlights The abnormalities on MRI should be correlated with the clinical findings. Higher signal of the Achilles tendon is a common postoperative finding. The fluid signal within the Achilles tendon graft indicates a rupture. Postoperative complications of Haglund’s syndrome should be assessed on MRI. Elongation of the Achilles tendon is seen after surgical or conservative treatment.

Presurgical Perspectives and Post-treatment Evaluation of Achilles Tendon Injuries

“…Achilles injury occurs due to chronic overuse in athletes, forceful dorsiflexion, as well as with medications (fluoroquinolones, corticosteroids, oral contraceptives, and hormone replacement therapy), obesity, and inflammatory disorders. 1 2 3 4 5 6 7 8 9 10 11 12 13 14…”

“…A longitudinal fluid signal represents interstitial intrasubstance tearing, whereas a focal fluid signal anywhere in the tendon is referred to as a partial-thickness tear. 6 Distal insertional tear ( Fig. 1 ) can be associated with upturn of the posterior calcaneal tubercle (Haglund's deformity).…”

“…Insertional tears are typically repaired with one or two large suture anchors, often combined with resection of a Haglund's deformity (bony prominence at the posterosuperior aspect of the calcaneal tubercle). 1 2 3 4 5 6 7 8 9 10 11 12 13 14…”

“…Clinical signs for recurrent tear are usually feeling a sudden “pop,” “snap,” or feeling that the person was hit in the back of the leg. 6 The timeline from surgery is an extremely crucial factor to help distinguish a recurrent tear from normal postoperative imaging during the first 12 weeks; there can normally be significant soft tissue edema during this period (and bone marrow edema for distal repair). It can be helpful to compare with preoperative imaging if available to be familiar with the extent of tendinosis and location of the original tear.…”

“…Achilles injury occurs due to chronic overuse in athletes, forceful dorsiflexion, as well as with medications (fluoroquinolones, corticosteroids, oral contraceptives, and hormone replacement therapy), obesity, and inflammatory disorders. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The spectrum of tendon degeneration and tear has led to the development of a variety of treatment options, ranging from minimally invasive to open surgical solutions. Beyond conservative management including rest, physical therapy, and medication, Achilles tendon treatment ranges from needle-based procedures, tenotomy, open versus percutaneous tendon repair, graft reconstruction, and flexor hallucis longus (FHL) transfer.…”