RUPTURED ACHILLES TENDON, A COMMON INJURY IN ATHLETES

Abstract

Introduction: The Achilles tendon also named calcaneal tendon, can be subjected to tensile loads up to 10 times the body weight. It is located on the posterior aspect of the lower leg and is the thickest tendon. This tendon accounts for 20% of all large tendon injuries. There is discussion on which is the best treatment, among which the percutaneous repair of the Achilles tendon has risk of injuring the sural nerve. When a sharp, explosive and sudden force is exerted on the Achilles tendon, rupture or tears can occur.most of these ruptures occur during sports; however, sometimes it happens in non-athletes or sedentary people.

Objective: To detail the current information related to Achilles tendon rupture and its treatment, as well as the different approach techniques.

Methodology: A total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 19 bibliographies were used because the other 10 articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish and English were: achilles tendon, Achilles tendon rupture, Achilles tendon treatment.

Results: Achilles tendon rupture is more frequent in adults between the third and fifth decade of life.  When it happens acutely they usually present sudden pain in the back of the leg accompanied by a "snapping". This pathology can be falsely diagnosed as an ankle sprain in 20% to 25%.  All patients require physical and orthopedic therapy and initial treatment consists of rest, elevation, pain control and functional orthopedic appliances. The advantages of non-surgical treatment are the avoidance of hospital admissions, wound complications and the risk of anesthesia. However, its main disadvantage lies in the increased risk of re-rupture, ranging up to 40%. Return to sporting life can be initiated 9 months after surgery as long as the patient is able to dorsiflex. Surgical treatment has a new rupture rate of 0.5% while non-surgical treatment has a rupture rate of approximately 40%.

Conclusions: The Achilles tendon is formed by the fusion of the gastrocnemius and soleus muscles in its distal part. The contraction of these two muscles generates a force that causes plantar flexion of the foot. The Achilles tendon is innervated essentially by the sural nerve. Signs of the affected person may include swelling, bruising and/or a noticeable alteration in the tendon. Thompson's test can be used to better assess the picture.  In athletics, basketball, diving, tennis, cycling, volleyball, gymnastics and others it is common to see tendon ruptures. If the patient presents with trauma to the lower leg, it is advisable to take X-rays in order to rule out fractures. The diagnosis can be confirmed with MRI or ultrasound. Surgical approach techniques for Achilles tendon repair include open, semi-open or limited open and percutaneous repair, although regardless of the technique of choice, restoration of tendon length must be ensured. Patients with significant medical comorbidities or those with relatively sedentary lifestyles are usually recommended to opt for non-surgical therapy. Surgical treatment mitigates the risk of re-rupture compared to conservative treatment; however, complication rates are much higher, and almost all athletes can return to physical activity without any limitations.