Spontaneous partial subcutaneous ruptures of the tendo achillis

Abstract

Partial subcutaneous rupture of the Achilles tendon has been considered a rare condition. Physical signs and symptoms have not been well established. The current review of 11 patients with 16 involved subcu taneous ruptures of the Achilles tendon treated at Southwestern Orthopedic Medical Group between the years 1971 and 1976 is intended to delineate the entity more clearly. Preoperative and postoperative symptoms and physical findings were evaluated and operatively and nonoperatively treated groups were compared. All tendons treated demonstrated either a palpable, partial defect in the Achilles tendon or were found at surgery to have a partial rupture. Thompson's test was negative in all patients. Eighty-one percent of injuries occured in males (13 of 16). The average age at diagnosis was 47.6 years. Pretherapy symp toms existed an average of 6½ months before defini tive therapy was instituted. Eighty-one percent of in juries were incurred during athletic activity (13 of 16). Forty-four percent had had from one to five prior injections of corticosteroid into the Achilles tendon area (7 of 16). The most common pretherapy symp toms were pain after variable degrees of activity (100%), limping (100%), the sensation of weakness (81 %), and intermittent or continuous swelling (35%). Seven of 16 tendons were treated with nonoperative therapy. The remaining nine tendons underwent sur gical exploration and repair. Those treated surgically were repaired by excision of the defect, suture of the opposing ends, and reinforcement of the repair with fascial strips turned down from the posterior gastroc nemius. All patients completed detailed question naires after therapy.

This study concludes (1) Partial subcutaneous rup ture of the tendo achillis occurs predominantly in young and middle-aged males involved in strenuous athletic activities; (2) predominant symptoms are pain, limping, weakness, and intermittent swelling; (3) pal pation of the Achilles tendon will generally reveal a palpable partial defect but Thompson's test will remain negative; (4) ablation of symptoms can usually be obtained nonoperatively but if symptoms persist be yond six months surgical exploration and repair is indicated; (5) the majority of patients can be expected to return to their preinjury level of activity.