Achilles tendon sleeve avulsion injuries: Diagnosis and management
An Achilles tendon sleeve avulsion injury is a rare and underrecognized variant of an Achilles tendon rupture. Given the disruption of the tendon-bone interface and the degenerative nature of this pathology, surgical reconstruction is typically indicated in order to allow for appropriate healing, the restoration of the gastrosoleus-Achilles complex anatomy, and optimized patient function. As such, it is critical for the evaluating provider to first recognize this specific injury pattern. The initial workup must include a lateral foot radiograph to evaluate for any associated small, ossific fragment, which would be representative of the actual sleeve avulsion pattern and any insertional Achilles enthesopathic changes and Haglund's prominence about the posterior calcaneus. Magnetic resonance imaging (MRI) can further characterize this injury and can be helpful for surgical planning. Given the relative paucity of cases, only retrospective case series of surgical outcomes and various surgical techniques have been published on the topic. Surgical repair typically necessitates an open repair of the avulsed tendon slip back to the calcaneus, typically after the removal of the avulsed fragment and the associated Haglund's prominence. Surgical outcomes have been good with the ability to safely and effectively return the patient to normal activity.
