(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Most Achilles tendon ruptures are caused by direct blows or closed injuries. Patients generally have a pathologic basis of degenerative changes before the occurrence of Achilles tendon rupture, and the trauma eventually causes the rupture of the Achilles tendon. In this case, the patient had a calf muscle strain 2 days before the visit, pulling the calf muscle and Achilles tendon, and was diagnosed with a closed Achilles tendon rupture by MRI.
Basic information】Male, 39 years old
Disease Type】 Achilles tendon rupture
Hospital】Harbin First Hospital
Date of consultation】March 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] Pain relief, good recovery, and basic recovery of ankle movement
I. Initial consultation
Two days ago, during a strenuous exercise, the patient pulled the calf muscle and the Achilles tendon, causing a closed rupture of the Achilles tendon, which resulted in normal ankle dorsiflexion and reduced plantarflexion (toe tensing). The rupture site was close to the middle of the Achilles tendon, the middle part of the Achilles tendon has relatively low blood supply and is prone to degenerative changes combined with local malnutrition, which can constitute the pathological basis of the Achilles tendon rupture. After communication, the patient understood the pathogenesis of the Achilles tendon rupture and agreed to be admitted to the hospital for Achilles tendon suture surgery to restore the function of the Achilles tendon. Since the Achilles tendon rupture was more than 48 hours old, there was severe local edema, so the swelling should be reduced by cold compresses first before surgery.
Second, the treatment process
During the procedure of Achilles tendon surgery, a medial incision of the Achilles tendon is made, the skin, subcutaneous and tendon sheath are sharply cut, the skin flap and tendon sheath are turned to the lateral side at the same time, the Achilles tendon is confirmed to be freshly ruptured, the separation of the severed end is obvious, the hematoma of the severed end of the Achilles tendon is cleared, and the severed end of the Achilles tendon is overlapped after combing the Achilles tendon and sutured at multiple points, and the range of motion of the ankle joint after suturing is ensured to be basically symmetrical with the healthy side and the incision is closed. During the surgery, the blood vessels around the Achilles tendon should be protected as much as possible to avoid damage to the blood vessels, so as to ensure the blood supply to the Achilles tendon and facilitate the repair of the Achilles tendon. After the operation, the long leg cast is fixed, the ankle joint is kept in plantar flexion at 30 degrees and the knee joint is flexed at 30 degrees. 3 weeks later, the long leg cast is changed to short leg cast in the hospital, and the cast can be removed in 6 weeks in general.
III. Treatment effect
The patient could elevate the lower limb and the pain symptoms were obviously improved in 5-7 days after the operation, and the sleep at night could be guaranteed. There were no symptoms of infection such as redness and swelling of the surgical incision, purulent exudation, etc. At the same time, no deep vein thrombosis in the lower extremity was seen after the vascular ultrasound review. However, the patient could complete the static contraction of the lower limb muscles under the guidance of the rehabilitation doctor, and ensure the multi-directional activities such as flexion and extension, adduction and abduction of the lower limb, etc. The patient was asked to follow up in outpatient clinic after 1 month.
IV. Notes
We are glad that the patient’s discomfort was relieved and the ankle joint activity was restored and he was discharged successfully.
1. In general, the patient can resume heel lifting activities in about 3 months after discharge, the painful symptoms will disappear completely and there will be no limping symptoms when walking, but the range of ankle joint activities will still be slightly reduced in the short term compared to the healthy side of the ankle joint, and the original working ability can be restored after half a year.
2. The Achilles tendon will be slightly thickened at the surgical suture site. Before the Achilles tendon is completely healed, the lower limb should not bear weight to avoid tearing the Achilles tendon again, and nutrition should be increased, such as eating prawns and yogurt to improve the immune system.
3, to prevent the surgical incision site infection, once the Achilles tendon infection, the Achilles tendon rupture recovery is slow, and also easy to appear at the Achilles tendon skin necrosis defect and Achilles tendon exposure, need long-term drug exchange to heal.
V. Personal insight
The patient’s Achilles tendon is avulsion type rupture, suitable for surgery, and the purpose of surgery is to repair the Achilles tendon and ensure the function of the Achilles tendon. The patient is relatively young and still needs to insist on sports in the future, so it is important to ensure the function of the Achilles tendon. During the surgical repair of the Achilles tendon, the peritendinous tissue needs to be carefully preserved to restore the blood supply to the Achilles tendon and to prevent the formation of local adhesions. Patients also need to develop confidence in their treatment and be able to undergo long-term cast immobilization and rehabilitation to work with their surgeon to ensure a smooth recovery of the Achilles tendon.