Giacobazzi Mario, Hansen Maxwell, Gologram Makayla, Mitchell Robert, Kasik Connor, Gritsiuta Andrei I
Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
St. Margaret's Illinois Valley Orthopedics, Peru, IL, USA.
AME Case Rep. 2023 Aug 25;7:36. doi: 10.21037/acr-23-61. eCollection 2023.
The Achilles tendon is the thickest tendon in the human body and is responsible for plantar flexion with muscle contraction. It is able to withstand tensile loads as large as ten times the body's weight or greater at times of peak stress on the tendon. Due to the repetitive and massive stress inflicted on the Achilles tendon, it is prone to injuries, especially in running and jumping athletes. Ruptures typically present after unsustainable stress placed on the tendon from rapid contraction with classic presentation of a sudden "pop". These injuries tend to occur in middle-aged men after atypical physical exertion with complaints of immense pain in the posterior lower leg.
This case examines a 20-year-old athlete presenting to the emergency department after sustaining a left calf injury while playing basketball. The patient suffered a full-thickness tear of the Achilles tendon with retraction and subsequent anterior and posterior tibiofibular ligament deficiency. This presentation is unique as he has a past medical history of an Achilles tear in the contralateral limb.
This study concluded that the bilateral Achilles tears in such a young patient were caused by anatomical blood supply watershed area to the Achilles tendon and anatomical ankle alignment abnormalities. This study provided a viable option to successfully repair complex Achilles tears via close reduction internal fixation (CRIF) with allograft matrix.
跟腱是人体最粗大的肌腱,负责在肌肉收缩时产生跖屈。在肌腱承受峰值应力时,它能够承受高达体重十倍甚至更大的拉伸负荷。由于跟腱承受反复且巨大的应力,它容易受伤,尤其是在跑步和跳跃运动员中。跟腱断裂通常在肌腱因快速收缩而承受无法承受的应力后出现,典型表现为突然的“啪”的一声。这些损伤往往发生在中年男性进行非典型体力活动后,伴有小腿后部剧痛。
本病例研究的是一名20岁运动员,他在打篮球时左小腿受伤后前往急诊科就诊。该患者的跟腱发生了全层撕裂,并伴有回缩,随后出现胫腓前、后韧带缺损。这种表现很独特,因为他对侧肢体有跟腱撕裂的既往病史。
本研究得出结论,如此年轻的患者出现双侧跟腱撕裂是由跟腱的解剖血供分水岭区域以及踝关节解剖对线异常所致。本研究提供了一种可行的选择,即通过同种异体移植物基质进行闭合复位内固定(CRIF)来成功修复复杂的跟腱撕裂。