Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort

Abstract

SummaryBackground: Achillodynia is common and includes Achilles tendinopathy, partial Achilles tears and Achilles tendon ruptures. However, we believe an additional pathology should be considered for Achillodynia differentials -the intratendinous tear (ITT). Methods: Examinations of 740 achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively. Results: 5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36.3 years (range 20-64), significantly lower than mid-tendon tendinopathy (8.48 years; p<0.01). 92% had concurrent Achilles tendinopathy. Elite sportspeople were more highly represented in the ITT than mid-tendon tendi nopathy groups (86.2% ITT group vs 13.8% mid-tendon AT group; p<0.01). Conclusions: ITTs should be actively searched for in patients with Achilles pathology, especially in elite male athletes with a history of high-impact pain. Prospective research is warranted concerning diagnosis and management. Level of evidence: IV.

Estado actual de la validez y fiabilidad de la valoración ecográfica del tendón de Aquiles

“…En el tendón de Aquiles normal aparece una estructura fibrilar hipoecoica con aspecto de cinta estrechamente empacada (11)(12). En la parte distal aparece la almohadilla de Kager, en su sector distal tiene una cierta cantidad de líquido de aspecto anecoico 13 No existen diferencias significativas a nivel ecográfico entre una tendinopatía crónica severa y un desgarro interno (14). Se pueden encontrar ensanchamientos localizados del tendón.…”

Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

“…In a recent study "intratendinous" tears were introduced in the differential diagnosis of Achilles tendon disorders. That pathology was ultrasonographically differentiated from partial tears by ber discontinuity "entirely within" the tendon [3].…”

“…Clinical presentation of Achilles tendon partial tears is unspeci c in most cases and is frequently not different from Achilles tendinopathy [1][2][3] or retrocalcaneal bursitis [4]. Suspicion of Achilles tendon partial tear is likely, when the patient experiences an acute onset, an audible pop, and a piercing pain during load [3,5]. Dependent on the size and the age of the lesion physical examination inconsistently presents Achilles tendon swelling or denting and calf muscle atrophy.…”

“…Diagnostic ultrasound imaging, colour Doppler, and/or MRI can underline the clinical suspicion [3,[7][8][9].…”

“…Ultrasound and power Doppler investigations demonstrated unspeci c ndings like localised swelling, reduced echogenity, and neovascularisation related to the injured area [3,7]. More speci c but inconsistent ndings were discontinuity of tendon bres and intratendineous anechogenic or low echogenic spots [3]. However, "especially partial ruptures of the Achilles tendon" are not su ciently detected by ultrasound [10].…”