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Abstract: The Achilles tendon can withstand high tension and rarely tears in daily life, but this 19-year-old patient was an athlete who frequently participated in sports activities resulting in chronic cumulative injury to the Achilles tendon, forming the pathophysiological basis for Achilles tendon tears. Under the effect of sudden trauma, the Achilles tendon tear occurred, affecting the function of weight-bearing walking and unable to continue to participate in sports. In order to restore the function of the Achilles tendon, surgical treatment was chosen to suture the Achilles tendon, and the patient gradually resumed life and sports.
Basic information】Male, 19 years old
Disease Type】Achilles tendon tear
Hospital】Harbin First Hospital
Date of consultation】May 2021
Treatment plan】Surgical treatment (Achilles tendon suture)
Treatment Period】7 days of hospitalization and 4 weeks of postoperative treatment to remove the cast
Results】The Achilles tendon was fixed with sutures, pain was relieved, and the ankle resumed movement.
I. Initial consultation
The patient was 19 years old, male, a wrestler, who had been training for a long time with high intensity, which weakened the strength of the Achilles tendon. Recently, during the training process, a sudden force was exerted, which caused a tear of the Achilles tendon, resulting in local swelling, pain, and limited movement. The patient’s calf triceps force could not be transmitted to the Achilles tuberosity, so surgery was required to re-suture the torn Achilles tendon. Conservative treatment of the Achilles tendon is relatively slow to recover and the Achilles tendon tension cannot be guaranteed, which can affect the patient’s athletic ability and lead to career interruption. After careful consideration, the patient chose to be admitted to the hospital for surgical treatment.
II. Treatment process
During the surgery, it was found that the patient’s Achilles tendon severed end was uneven in a cauda equina shape, and it was difficult to suture the stump, which would affect the flexion and extension function of the ankle joint. Therefore, the fibers of the Achilles tendon severed end were slightly sutured during the surgery, and a tendon flap was used to reinforce the tendon, which could increase the strength of the Achilles tendon and reduce the possibility of re-rupture. After the surgery, a cotton leg bandage was applied and the long leg cast was kept at 60° of knee flexion and 30° of ankle flexion, which was changed to a short leg cast after 3 weeks, while the cast was removed after 4 weeks to practice active flexion and extension of the ankle joint. 6 weeks later, a higher heel shoe was worn to walk on the ground and the heel was gradually lowered to make the Achilles tendon gradually apply normal tension and avoid rupture of the Achilles tendon after surgery.
III. Treatment effect
After 7 days of hospitalization, the patient basically recovered and was allowed to be discharged home for recuperation. The patient was instructed to follow the rehabilitation plan, and after 4 weeks, the cast was removed, the patient’s ankle range of motion was significantly improved, the calf muscle atrophy was completely corrected, and the patient was able to gradually resume normal weight-bearing walking and complete basic life movements. The patient was satisfied with the treatment result.
IV. Precautions
I am happy for the patient that the Achilles tendon function was completely restored 6 months after discharge and the local pain disappeared completely! However, since the Achilles tendon tear is the final result of chronic accumulative injury, the patient should be advised to pay attention to protecting the Achilles tendon during daily training, avoiding sudden force on the Achilles tendon and using ankle brace for protection if necessary. If the Achilles tendon becomes painful during the training process, rest and limit the activity in time. After promoting the repair of the Achilles tendon, then gradually resume training intensity, avoid sudden overload training, resulting in the Achilles tendon tear again.
V. Personal insight
The patient had an Achilles tendon tear, and surgical treatment is more suitable, mainly because the athlete needs to restore the tension of the Achilles tendon quickly in a short period of time in order to complete the competitive sports and ensure the corresponding competition results. Moreover, the torn end of the Achilles tendon is irregularly shaped and conservative treatment is relatively ineffective. After surgical repair of the Achilles tendon, patients still need to be careful to avoid retearing the Achilles tendon. Repeated tears of the Achilles tendon in the same area can not only make the repair more difficult, but also affect performance.