link
Bookmarks
Achilles Tendon Injury
Corrie M. Yablon, MD; Julia R. Crim, MD; Donna G. Blankenbaker, MD, FACR
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Subscribe
0
16
0
1

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Paratenon: U-shaped connective tissue surrounding posterior, medial, lateral Achilles
              • Found in Achilles and other tendons that lack true tendon sheath
              • Provides blood supply to tendon, reduces friction
            • Paratenonitis: inflammation of paratenon
              • a.k.a. peritendinitis, paratendinitis, peritendinopathy
              • Inflammation of paratenon that may also involve Kager fat pad
            • Tendinopathy: acute and chronic tendon pathology excluding rupture
              • Tendon degeneration and minor inflammation coexist in abnormally thickened tendon
              • Insertional: 25% associated with Haglund deformity
              • Noninsertional: occurs at watershed area, 2-6 cm proximal to insertion
            • Achilles watershed area: area of relative hypovascularity in mid tendon, 2-6 cm proximal to insertion

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              • Relevant Anatomy

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Maffulli N et al: Achilles tendinopathy. Foot Ankle Surg. 26(3):240-9, 2020
                                              2. Steinmann S et al: Spectrum of tendon pathologies: triggers, trails and end-state. Int J Mol Sci. 21(3), 2020
                                              3. Barg A et al: Surgical strategies for the treatment of insertional achilles tendinopathy. Foot Ankle Clin. 24(3):533-59, 2019
                                              4. Bäcker HC et al: MRI assessment of degeneration of the tendon in achilles tendon ruptures. Foot Ankle Int. 40(8):895-9, 2019
                                              5. Jennings MM et al: Updates in tendinopathy treatment options. Clin Podiatr Med Surg. 36(4):543-52, 2019
                                              6. Müller SA et al: The role of the paratenon in Achilles tendon healing: a study in rats. Am J Sports Med. 46(5):1214-9, 2018
                                              7. Lawrence JE et al: Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 99-B(1):87-93, 2017
                                              8. Ahmad J et al: Treatment of myotendinous Achilles ruptures. Foot Ankle Int. 34(8):1074-8, 2013
                                              9. Fernández-Sarmiento JA et al: Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am. 95(3):246-55, 2013
                                              10. Thevendran G et al: The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 97(1):9-20, 2013
                                              11. Soroceanu A et al: Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94(23):2136-43, 2012
                                              12. Calleja M et al: The Achilles tendon. Semin Musculoskelet Radiol. 14(3):307-22, 2010
                                              13. Willits K et al: Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 92(17):2767-75, 2010
                                              14. Courville XF et al: Current concepts review: noninsertional Achilles tendinopathy. Foot Ankle Int. 30(11):1132-42, 2009
                                              15. Luck MD et al: High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 37(12):1129-33, 2008
                                              16. Richards PJ et al: Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil. 30(20-22):1651-65, 2008
                                              17. Sode J et al: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 63(5):499-503, 2007
                                              18. Chiodo CP et al: Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 27(4):305-13, 2006
                                              19. Dobson MH et al: Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 88(5):1160; author reply 1160, 2006
                                              20. Hartgerink P et al: Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 220(2):406-12, 2001
                                              21. Schweitzer ME et al: MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 175(3):613-25, 2000
                                              Related Anatomy
                                              Loading...
                                              Related Differential Diagnoses
                                              Loading...
                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Paratenon: U-shaped connective tissue surrounding posterior, medial, lateral Achilles
                                                          • Found in Achilles and other tendons that lack true tendon sheath
                                                          • Provides blood supply to tendon, reduces friction
                                                        • Paratenonitis: inflammation of paratenon
                                                          • a.k.a. peritendinitis, paratendinitis, peritendinopathy
                                                          • Inflammation of paratenon that may also involve Kager fat pad
                                                        • Tendinopathy: acute and chronic tendon pathology excluding rupture
                                                          • Tendon degeneration and minor inflammation coexist in abnormally thickened tendon
                                                          • Insertional: 25% associated with Haglund deformity
                                                          • Noninsertional: occurs at watershed area, 2-6 cm proximal to insertion
                                                        • Achilles watershed area: area of relative hypovascularity in mid tendon, 2-6 cm proximal to insertion

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          • Relevant Anatomy

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Maffulli N et al: Achilles tendinopathy. Foot Ankle Surg. 26(3):240-9, 2020
                                                                                          2. Steinmann S et al: Spectrum of tendon pathologies: triggers, trails and end-state. Int J Mol Sci. 21(3), 2020
                                                                                          3. Barg A et al: Surgical strategies for the treatment of insertional achilles tendinopathy. Foot Ankle Clin. 24(3):533-59, 2019
                                                                                          4. Bäcker HC et al: MRI assessment of degeneration of the tendon in achilles tendon ruptures. Foot Ankle Int. 40(8):895-9, 2019
                                                                                          5. Jennings MM et al: Updates in tendinopathy treatment options. Clin Podiatr Med Surg. 36(4):543-52, 2019
                                                                                          6. Müller SA et al: The role of the paratenon in Achilles tendon healing: a study in rats. Am J Sports Med. 46(5):1214-9, 2018
                                                                                          7. Lawrence JE et al: Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 99-B(1):87-93, 2017
                                                                                          8. Ahmad J et al: Treatment of myotendinous Achilles ruptures. Foot Ankle Int. 34(8):1074-8, 2013
                                                                                          9. Fernández-Sarmiento JA et al: Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am. 95(3):246-55, 2013
                                                                                          10. Thevendran G et al: The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 97(1):9-20, 2013
                                                                                          11. Soroceanu A et al: Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94(23):2136-43, 2012
                                                                                          12. Calleja M et al: The Achilles tendon. Semin Musculoskelet Radiol. 14(3):307-22, 2010
                                                                                          13. Willits K et al: Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 92(17):2767-75, 2010
                                                                                          14. Courville XF et al: Current concepts review: noninsertional Achilles tendinopathy. Foot Ankle Int. 30(11):1132-42, 2009
                                                                                          15. Luck MD et al: High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 37(12):1129-33, 2008
                                                                                          16. Richards PJ et al: Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil. 30(20-22):1651-65, 2008
                                                                                          17. Sode J et al: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 63(5):499-503, 2007
                                                                                          18. Chiodo CP et al: Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 27(4):305-13, 2006
                                                                                          19. Dobson MH et al: Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 88(5):1160; author reply 1160, 2006
                                                                                          20. Hartgerink P et al: Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 220(2):406-12, 2001
                                                                                          21. Schweitzer ME et al: MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 175(3):613-25, 2000