Achilles Tendon Rupture

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Achilles Tendon Rupture

Authors, Editors, Case Information Author: Kelsey Bacidore, MD Affiliation: Loyola University Senior Editor: William Berrigan, MD Clinical Vignette: A 38-year-old female was unable to bear weight on her left leg after landing on her foot while playing volleyball. She felt a pop with resulting pain in her calf. There was a palpable deformity proximal to the Achilles insertion and minimal ankle plantar flexion was notedon the Thompson test. Type of Probe Used: 13-6 MHz Linear Transducer Unlabeled Long Axis View of the Achilles Tendon Unlabeled Long Axis View of the Achilles Tendon Labeled Long Axis View of the Achilles Tendon Labeled Long Axis View of the Achilles Tendon with evidence of tendon discontinuity and hypoechoic signal within the area of discontinuity consistent with a hematoma. #3 - Video View Video Long axis proximal to distal cine of the Achilles tendon. There is an anechoic defect where the distal (right) portion of the tendon ruptured from the proximal (left) portion. #4 - Video View Video Long axis proximal to distal cine of the Achilles tendon with focus on the hematoma. #5 - Video View Video Long axis dynamic Achilles tendon evaluation with passive ankle plantarflexion and dorsiflexion. Movement of the distal tendon can be seen while the proximal tendon remains immobile consistent with Achilles tendon rupture. Interpretation Image Interpretation: Achilles tendon discontinuity with hematoma consistent with Achilles tendon rupture. Movement of the distal tendon without concurrent movement of the proximal tendon during plantar and dorsiflexion further confirming the diagnosis. Teaching Pearl: When evaluating the Achilles tendon, it can be helpful to scan with the patient prone and the foot hanging off the end of the table. Begin in long axis at the calcaneal insertion and follow the tendon proximally to the myotendinous junction, and then repeat in short axis to avoid underestimating a potential tear. Achilles tendon rupture is confirmed by presence of tendon discontinuity, hematoma, retracted tendon ends, and lack of synchronized proximal-distal tendon motion during gentle dynamic plantarflexion and dorsiflexion. Describing gap size and tendon apposition can be one component that helps guide management discussions. References: 1. Fenech M, Ajjikuttira A, Edwards H. Ultrasound assessment of acute Achilles tendon rupture and measurement of the tendon gap. Australas J Ultrasound Med. 2024;27(2):106-119. doi:10.1002/ajum.12384 2. Billone LM, Allred SJ, Flores DV. US of acute tendon tears. Radiographics. 2024;44(12):e240060. doi:10.1148/rg.240060 3. Qureshi AA, Ibrahim T, Rennie WJ, Furlong A. Dynamic ultrasound assessment of the effects of knee and ankle position on Achilles tendon apposition following acute rupture. J Bone Joint Surg Am. 2011;93(24):2265-2270. doi:10.2106/JBJS.J.01757
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Achilles Tendon

Labeled Long Axis View of the Achilles Tendon

#3 - Video

#4 - Video

#5 - Video

Interpretation

UPCOMING EVENTS

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