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Sports Trauma
ACHILLES TENDON RUPTURE:
The Achilles tendon is the tendon that connects the calf muscle (gastrocnemius)
to the heel bone (calcaneus). This is the tendon that is just below the skin
at the back of the ankle. A ruptured (or torn) tendon may occur when the
tendon has been structurally weakened by an ongoing tendonitis, or when a
completely healthy tendon is subjected to a sudden, unexpected force. As a
result, the tendon tears.
The treatment options for a complete rupture of the tendon include surgery
followed by splinting, or splinting alone. There are advantages and
disadvantages to each technique. The re rupture rate is significantly
decreased if the tendon is surgically repaired.
The repair consists of suturing the two ends of the tendon together.
However, if the rupture is very low, an anchor into the calcaneus may have
to be placed to provide better fixation.
Anesthesia for this procedure is either regional (spinal block) or general.
You will be able to talk about the options with your anesthesiologist the
day of surgery. Surgery time is approximately an hour and is typically an
ambulatory (in and out the same day) procedure.
Following a repair of the Achilles tendon, the patient is non weight bearing
for a full 6 weeks. The patient will leave the hospital in a splint, which
will be removed at the first post op visit (10-14 days). At that visit a CAM
boot, which is to be worn for the next 4-6 weeks, is placed on the patient.
Physical therapy typically begins after the sutures are removed and full
return to sport is around 6 months.
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QUADRICEPS TENDON RUPTURE/ PATELLA TENDON RUPTURE:
The quadriceps tendon and patellar tendon (or patellar ligament) are
parts of the extensor mechanism of the knee. It is the extensor mechanism
that allows us to straighten our knee or perform a kicking motion.
Typically, patients who experience this injury fall on to a partially bent
knee. When the quadriceps muscle contracts to break the fall, the quadriceps
tendon or patellar tendon cannot withstand the force and ruptures.
Both Tendons are repaired in a similar manner. In the majority of cases, the
suture anchors are placed in the kneecap and the tendon is pulled down to
its proper attachment.
Surgical time is approximately an hour. Anesthesia is regional (spinal
block) or general. Most patients are able to leave the day of surgery.
Following surgery, the patient is placed in a knee brace locked in extension
and is placed on crutches, non weight bearing for 6 weeks. Physical therapy
is started within a week following surgery to work on range of motion.
Return to sport is usually around 6 months.
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The BICEPS TENDON and HAMSTRING TENDON are other tendon ruptures that are
sometimes addressed surgically. Both are repaired by suturing the torn
tendon to its bony insertion.
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