Figure. Sagittal MRI scan showing a proximal Achilles tendon rupture.
A 19-year-old woman presents to the office with right calf pain after a lacrosse injury that occurred 2 days earlier. She was making a sharp cutting maneuver in practice and felt a pop in the back of her heel. She was unable to continue playing and her ankle quickly became swollen over the next day. On physical examination, the patient has tenderness to palpation over the myotendinous junction of the Achilles tendon and a positive Thompson test (also known as Simmonds-Thompson test). Figure 1 is a sagittal magnetic resonance imaging scan showing a proximal Achilles tendon rupture.
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Achilles tendon ruptures are common injuries that typically occur in middle-aged men during sporting activities.1 The majority of Achilles ruptures (75%) typically occur in the midsubstance of the tendon or within 6 cm of where the tendon attaches to the calcaneus. Ruptures in this location are typically treated surgically in the population of active adults as the rate of reinjury is higher with nonoperative treatment than with surgical treatment. Ruptures of the Achilles tendon at the myotendinous junction, as in this case, are less common (<15% of all Achilles ruptures).1,2
Ahmad et al treated 30 patients with acute myotendinous junction injuries over a 6-year period with conservative treatment consisting of 3 weeks of non–weight-bearing followed by 3 weeks of progressive weight-bearing in a boot. At 6 weeks, physical therapy was initiated for range of motion exercises.1
The study concluded that nonsurgical treatment of myotendinous Achilles tendon rupture resulted in a high rate of healing and return to function. Of the 30 patients followed in the study, none of the patients reinjured the tendon after 3 years.1
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
1. Ahmad J, Repka M, Raikin SM. Treatment of myotendinous Achilles ruptures. Foot Ankle Int. 2013;34(8):1074-8. doi:10.1177/1071100713483115
2. Kadakia AR, Dekker RG II, Ho BS. Acute Achilles tendon ruptures: an update on treatment. J Am Acad Orthop Surg. 2017;25(1):23-31. doi:10.5435/JAAOS-D-15-00187