Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

Abstract

This case presents symptom resolution for a long-distance runner with chronic Achilles tendinopathy (AT), following a partial tear of his Achilles tendon. The patient reported a sudden pain during a morning run, with preserved function. Three hours postinjury, he was reviewed in a musculoskeletal clinic. An ultrasound scan confirmed a partial Achilles tear, associated with significant Doppler activity. His index of AT severity The Victorian Institute of Sports Assessment - Achilles Questionnaire (VISA-A) 4 hours postinjury was markedly higher compared with 2 weeks preinjury, indicating reduced symptom severity. A follow-up scan 4 weeks postinjury showed minimal mid-portion swelling and no signs of the tear. His VISA-A score showed continued symptom improvement. This case represents resolution of tendinopathic symptomatology post partial Achilles tear. While the natural histories of AT and Achilles tears remain unknown, this case may indicate that alongside the known role of loading, inflammation may be a secondary mediator central to the successful resolution of AT pain.

Keywords: achilles tendinitis; sports and exercise medicine; tendon rupture; tendonopathies.

Figure 1

The left Achilles tendon 3 hours postinjury (A–C), with partial tear measuring 0.22 cm by 0.25 cm outlined (B). The tendon showed significant Doppler activity at the time of the scan (C). The GE 12 L linear array ultrasound transducer probe was used.

Figure 2

The left Achilles Tendon 2 weeks prior to injury. The GE 12 L linear array ultrasound transducer probe was used.

Figure 3

The left Achilles tendon 2 weeks postinjury. There is reduced yet persistent evidence of tear pathology (A; arrow pointing towards the location of the original tear) compared with the scan at the time of injury. The tendon showed continued Doppler activity (B) which was reduced compared with the scan taken at the time of injury. The GE 12 L linear array ultrasound transducer probe was used.

Figure 4

Ultrasound scans of the patient’s affected (A) and contralateral (B) Achilles tendons 2 years after the injury. There is very little difference between the tendons structurally, and Doppler activity is virtually absent in both the scans.

Figure 5

The effect of tendon injury (tear) on tissue quality and function in healthy tissue, and proposed capacity of injury and its inflammation to promote remodelling and increased function (adapted from Snedeker and Foolen29).