Achilles Tendon Disorders：跟腱疾病.pptVIP

Achilles Tendon Disorders Daniel Penello Foot Ankle Rounds Anatomy Largest tendon in the body Origin from gastrocnemius and soleus muscles Insertion on calcaneal tuberosity Anatomy Lacks a true synovial sheath Paratenon has visceral and parietal layers Allows for 1.5cm of tendon glide Anatomy Paratenon Anterior – richly vascularized The remainder – multiple thin membranes Anatomy Blood supply Musculotendinous junction Osseous insertion on calcaneus Multiple mesotenal vessels on anterior surface of paratenon (in adipose) Transverse vincula Fewest @ 2 to 6 cm proximal to osseous insertion Physiology Remarkable response to stress Exercise induces tendon diameter increase Inactivity or immobilization causes rapid atrophy Age-related decreases in cell density, collagen fibril diameter and density Older athletes have higher injury susceptibility Biomechanics Gastrocnemius-soleus-Achilles complex Spans 3 joints Flex knee Plantar flex tibiotalar joint Supinate subtalar joint Up to 10 times body weight through tendon when running Achilles Tendon Rupture Pathophysiology Repetitive microtrauma in a relatively hypovascular area. Reparative process unable to keep up May be on the background of a degenerative tendon Achilles Tendon Rupture: Textbook Facts Antecedent tendinitis/tendinosis in 15% 75% of sports-related ruptures happen in patients between 30-40 years of age. Most ruptures occur in watershed area 4cm proximal to the calcaneal insertion. Achilles Tendon Rupture History Feels like being kicked in the leg Case reports of fluoroquinolone use, steroid injections Mechanism Eccentric loading (running backwards in tennis) Sudden unexpected dorsiflexion of ankle (Direct blow or laceration) Physical Exam Prone patient with feet over edge of bed Palpation of entire length of muscle-tendon unit during active and passive ROM Compare tendon width to other side Note tenderness, crepitation, warmth, swelling, nodularity, palpable defects Achilles Tendon Rupture Physical