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Abstract: The Achilles tendon is subjected to high forces in daily activities, and chronic cumulative injuries can lead to a weakening of the Achilles tendon. A sudden strain of the calf due to strenuous exercise or participation in heavy physical labor on the basis of this lesion can cause an acute Achilles tendon rupture. The patient in this article had a calf strain 18 hours prior to the visit that caused the rupture of the Achilles tendon, which was confirmed by MRI.
Basic information】Male, 52 years old
Disease Type】 Achilles tendon rupture
Hospital】Harbin First Hospital
Date of Consultation】June 2021
Treatment plan】Surgical treatment (Achilles tendon suture) + cast fixation
Treatment Period】7 days of inpatient treatment, 1 month of outpatient follow-up, 3 months of review
Results】The Achilles tendon was sutured and fixed, pain was relieved, and normal walking resumed.
I. Initial consultation
18 hours ago, the patient was lifting a heavy object while participating in labor, and the calf muscle suddenly contracted violently, causing excessive strain on the Achilles tendon, and the patient had a history of multiple injuries to the Achilles tendon and chronic inflammation and degeneration of the Achilles tendon, so the Achilles tendon rupture occurred under the sudden external force, which was a closed Achilles tendon rupture. The MRI shows disruption of the continuity and integrity of the Achilles tendon, which requires consideration of surgical treatment. Untreated Achilles tendon rupture will affect the normal force of the calf muscles and restrict the movement of the ankle joint, resulting in weakness in walking and even clinical symptoms such as claudication, which will cause serious adverse effects on future life, and should be treated early, otherwise contracture of the Achilles tendon will occur and the treatment will be significantly more difficult and the recovery effect will become worse. After communicating with the patient, the patient has fully understood the necessity of Achilles tendon rupture treatment.
Second, the treatment process
A longitudinal incision was made on the medial side of the Achilles tendon, the subcutaneous tissue was peeled off, the Achilles tendon and tendon sheath were turned over at the same time, the hematoma was cleared and the Achilles tendon rupture was revealed with a cauda equina change, the severed end of the upper Achilles tendon was overlapped and sutured to restore the integrity and continuity of the Achilles tendon, and the normal position of the ankle and foot were observed bilaterally during the surgery and the incision was closed after confirming symmetry. After surgery, a long-leg cast was used for immobilization, including the ankle and knee joints, to confirm relaxation of the Achilles tendon area. The patient undergoes postoperative immobilization in a plantarflexion long-leg cast, which is usually immobilized for 3-4 weeks, and then changes to a neutral foot position, which is immobilized for 2-3 weeks. After removal of the cast, the patient needs to bear weight under the protection of a brace for 6 weeks.
III. Treatment effect
The patient’s pain and swelling were significantly relieved within 1 week after surgery, and the patient was able to elevate the lower extremity voluntarily about 3 days after surgery without complications such as deep vein thrombosis in the lower extremity and infection of the surgical incision, and the patient was instructed to follow up at the clinic after 1 month. The Achilles tendon will grow gradually in the relaxed state, but the growth rate is relatively slow, mainly because of the relatively poor blood supply to the rupture site of the Achilles tendon, and the patient has fully understood the postoperative recovery process.
IV. Precautions
The patient’s pain was relieved after treatment and he resumed normal walking, I am very happy for this, the patient also needs to pay attention to the following points.
1, the patient needs to go to the orthopedic outpatient clinic regularly after discharge for follow-up review. After the surgery of Achilles tendon rupture suture, secondary infection may occur due to the decrease of local immune function, therefore, before the removal of surgical sutures, the surgical incision should be closely observed, and it usually takes about 2 weeks to remove the surgical sutures.
2, at the same time home during the affected limb can not be weight-bearing, easy to the Achilles tendon rupture site again tear, affect the smooth healing of the Achilles tendon.
3, the faster the local swelling of the Achilles tendon subsides, the better the recovery of local blood supply, so patients should continue to elevate the lower limb to speed up venous return and lymphatic flow, thereby reducing tissue tension and promoting Achilles tendon healing.
4. Increase nutrition appropriately, such as eating lean meat, fish, etc.
V. Personal insight
The acute Achilles tendon rupture occurred in this case, the separation of the severed end is obvious, through conservative treatment such as plaster fixation, usually can not ensure that the strength and tension of the Achilles tendon back to normal, easy to produce plantar flexion power weakening, and is not suitable for this patient. The Achilles tendon rupture is to restore the integrity of the Achilles tendon in order to achieve the therapeutic goal of maintaining plantarflexion strength in the ankle area. In addition, patients need to pay attention to the protection of the Achilles tendon in their daily life to avoid repeated Achilles tendon injuries.