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Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.

Publication ,  Journal Article
Huh, J; Easley, ME; Nunley, JA
Published in: Foot Ankle Int
June 2016

BACKGROUND: An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. METHODS: A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. RESULTS: Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. CONCLUSIONS: Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional disease, while engaged in athletic activity. Suture anchor fixation, combined with addressing concomitant insertional pathology, was a reliable and safe technique for the operative management of Achilles tendon sleeve avulsions. The majority of patients returned to their preinjury levels of work and recreational activity. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Duke Scholars

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2016

Volume

37

Issue

6

Start / End Page

596 / 604

Location

United States

Related Subject Headings

  • Visual Analog Scale
  • Tendinopathy
  • Suture Techniques
  • Rupture
  • Retrospective Studies
  • Patient Satisfaction
  • Pain Measurement
  • Orthopedics
  • Humans
  • Calcaneus
 

Citation

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Huh, J., Easley, M. E., & Nunley, J. A. (2016). Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions. Foot Ankle Int, 37(6), 596–604. https://doi.org/10.1177/1071100716629778
Huh, Jeannie, Mark E. Easley, and James A. Nunley. “Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.Foot Ankle Int 37, no. 6 (June 2016): 596–604. https://doi.org/10.1177/1071100716629778.
Huh J, Easley ME, Nunley JA. Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions. Foot Ankle Int. 2016 Jun;37(6):596–604.
Huh, Jeannie, et al. “Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.Foot Ankle Int, vol. 37, no. 6, June 2016, pp. 596–604. Pubmed, doi:10.1177/1071100716629778.
Huh J, Easley ME, Nunley JA. Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions. Foot Ankle Int. 2016 Jun;37(6):596–604.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2016

Volume

37

Issue

6

Start / End Page

596 / 604

Location

United States

Related Subject Headings

  • Visual Analog Scale
  • Tendinopathy
  • Suture Techniques
  • Rupture
  • Retrospective Studies
  • Patient Satisfaction
  • Pain Measurement
  • Orthopedics
  • Humans
  • Calcaneus