(Disclaimer: This article is for general science purposes only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Achilles tendon tear is a common sports injury. This 25-year-old young female patient failed after conservative treatment and was confirmed by MRI to have an old Achilles tendon tear and showed walking dysfunction. Surgical treatment was taken to repair the Achilles tendon, restore the continuity and stability of the Achilles tendon, and with rehabilitation training, the patient gradually recovered normal walking ability.
Basic information】Female, 25 years old
Disease Type】Old tear of Achilles tendon
Hospital】Harbin First Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (Achilles tendon repair)
Treatment Period】7 days of inpatient treatment and regular outpatient follow up
Results】The Achilles tendon was repaired and fixed, the pain was relieved, and the ankle resumed movement.
I. Initial consultation
The patient, a 25-year-old female dancer, had a torn Achilles tendon caused by an indirect external force during her stage performance. On examination, the patient was found to have Achilles tendon lengthening, resting position of the affected ankle joint in prone position, reduced plantarflexion angle, palpable depression between the severed ends of the Achilles tendon, and positive pinching of the calf triceps muscle. Follow-up MRI was taken to confirm the old tear of the Achilles tendon.
II. Treatment history
In order to resume his dancing career, the patient agreed to undergo surgery for Achilles tendon repair. During the surgery, extensive adhesions were found between the subcutaneous fat, Achilles tendon circumference and Achilles tendon, and both had degenerative changes at the tendon circumference, Achilles tendon and severed end as well as scar connections between the severed ends, while the metatarsal tendon remained intact. Due to the presence of shortening of the Achilles tendon, a V-Y shortening suture was performed along with a reversal of the gastrocnemius tendon for reinforcement. During the procedure, the hardened, discolored, and thickened degenerative tissue was excised until the white tendon fibers were exposed, the surgical incision was flushed, and the deep fascia, subcutaneous tissue, and skin were sutured layer by layer. Postoperatively, the cotton leg was compressively bandaged and the long leg cast posterior brace was used to fix the knee joint in mild flexion. Postoperatively, the patient cooperated with rehabilitation exercises and gradually resumed padded heel walking, jogging and brisk running.
III. Treatment effect
After the Achilles tendon repair surgery and rehabilitation training, the patient’s Achilles tendon pain, weakness in heel lifting and claudication disappeared completely, the flexibility and range of motion of the ankle joint were completely restored, the strength and power of the calf muscles were significantly improved, and the patient was gradually able to resume normal walking ability. The patient was discharged after 7 days of hospitalization. After repeated re-examinations, no local adhesions were formed in the Achilles tendon, and the strength of the calf triceps muscle was basically the same as before the injury, and the patient was able to complete regular dance movements.
IV. Precautions
The patient was discharged from the hospital with a fully recovered Achilles tendon and was able to perform strenuous movements, so I was happy for her.
However, due to the old tear of the Achilles tendon, it is still suggested that the patient had a slight injury to the Achilles tendon in the past, so she still needs to be advised to pay attention to protect the Achilles tendon when she completes the dance movements and avoid sudden overload of the Achilles tendon. If the Achilles tendon is painful, swollen or other clinical symptoms, it is necessary to brake the ankle joint in time to rest and promote the repair of the Achilles tendon tissue before gradually resuming the dance movement to avoid accumulative damage to the Achilles tendon, which may lead to another tear of the Achilles tendon. Although the patient has torn the Achilles tendon and has failed conservative treatment, there is no need for psychological stress. Active rehabilitation after surgery can completely restore the function of the Achilles tendon, and dance training can still be continued.
V. Personal insight
This patient had an old Achilles tendon tear and changed from conservative treatment to surgery to complete the Achilles tendon repair. When this patient had a torn Achilles tendon, the speed of Achilles tendon recovery would have been better if the treatment was chosen according to the specific situation of the torn Achilles tendon and the requirements for athletic ability. Improperly selected treatment modalities often have varying degrees of impact on Achilles tendon repair and Achilles tendon function, which can result in slower or poorer recovery of athletic ability. Care should be taken to protect the Achilles tendon during future training to prevent re-tears.