We report a case of bilateral Achilles tendon xanthoma as the first clinical manifestation of familial hypercholesterolemia. We review the literature and stress the need for orthopaedic surgeons to be familiar with this disease. An early diagnosis of this metabolic disorder is important to institute medical therapy and to alter the course of the disease before the onset of coronary artery disease.
. BrunzellJ.D.: Disorders of lipoprotein metabolism.InWyngaardenJ.B.SmithL.H.Jr.BennettJ.C. (eds.), Cecil Textbook of Medicine, 19th Ed.Philadelphia, Saunders, 1992, p. 10984–109845
3.
. BudeO.R.AdlerR.S.BassetD.R.: Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography.AJR Am. J. Roentgenol., 162: 913–917, 1994
4.
. DoyleJR.: Tendon xanthoma: a physical manifestation of hyperlipidemia.J. Hand Surg., 13A: 238–241, 1988
5.
. DurringtonP.N.AdamsJ.E.BeastallM.D.: The assessment of Achilles tendon size in primary hypercholesterolemia by computed tomography.Atherosclerosis, 45: 345–358, 1982
6.
. DussautR.G.KaplanP.A.RoedererG.: MR imaging of Achilles tendon in patients with familial hyperlipidemia.AJR Am. J. Roentgenol., 164: 403–407, 1995
7.
. FaheyJ.J.StarkH.H.DonovanW.F.DrennanD.B.: Xanthoma of Achilles tendon: seven cases with familial hyper-betalipoproteinemia.J. Bone Joint Surg., 55A: 1197–211, 1973
. FriedmanM.S.: Xanthoma the Achilles tendon.J. Bone Joint Surg., 29: 760–766, 1947
10.
. GinsbergH.N.GoldsmithS.J.VallabhajosulaS.: Noninvasive imaging of 99nmtechnetium-labeled low density lipoprotein uptake by tendon xanthomas in hypercholesterolemic patients.Arteriosclerosis, 10: 256–262, 1990
11.
. GoldsteinJ.L.BrownN.S.: Familial hypercholesterolemia.InScriberC.R.BeaudetA.L.SlyW.S.ValleD. (eds.), The metabolic basis of inherited disease. New York, McGraw-Hill, pp. 1225–1250, 1989
12.
. Koivunen-NiemeläT.AlanenA.ViikariJ.: Sonography of the Achilles tendon in hypercholestrolaemia.J. Intern. Med., 234: 401–405, 1993
13.
. LeeC.K.WeissA.B.: Xanthomas of the Achilles tendon: a case report of bilateral total resection and tendon reconstruction using the fascia lata.J. Bone Joint Surg., 62A: 666–669, 1980
. MuranoS.ShinomiyaM.ShiraiK.SaitoY.YoshidaS.: Characteristic features of long-living patients with familial hypercholesterolemia in Japan.J. Am. Geriatr. Soc, 41: 253–257, 1993
16.
. Portabella-BlaviaF.Orduña-SerraM.Oliver-FarG.: Xantoma de tendon de Aquiles por hipercolesterolemia.Rev. Ortop. Traum., 41: 305–307, 1997
17.
. RoyS.K.KumarS.N.: Xanthoma of Achilles tendon.J. Orthop., 17: 63–65, 1983
18.
. SarafS.K.SharmaS.V.: Reconstruction for xanthoma of the Achilles tendon.Int Orthop, 16: 37–38, 1992
19.
. SeidlO.KellerC.BergerH.WolframG.ZöllnerN.: Xeroradiographic determination of Achilles tendon thickness in familial hypercholesterolaemia confirmed by tissues cultures.Atherosclerosis, 46: 163–172, 1983
20.
. TomitaT.OchiT.FushimiH.MatsuzawaY.OnoK.: Reconstruction of the Achilles tendon for xanthoma: finding at operative re-exploration—a case report.J. Bone Joint Surg., 76A: 444–447, 1994
21.
. van KampenA.KubatK.KrulsH.J.SlooffTJ.: Xanthomas of Achilles tendon: a case report.Acta Orthop. Belg., 50: 101–106, 1984
