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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 8, pp 2268–2273 | Cite as

MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

  • David N. Garras
  • Steven M. Raikin
  • Suneel B. Bhat
  • Nicholas Taweel
  • Homyar Karanjia
Clinical Research

Abstract

Background

Achilles tendon ruptures are common in middle-aged athletes. Diagnosis is based on clinical examination or imaging. Although MRI is commonly used to document ruptures, there is no literature supporting its routine use and we wondered whether it was necessary.

Questions/purposes

We (1) determined the sensitivity of physical examination in diagnosing acute Achilles ruptures, (2) compared the sensitivity of physical examination with that of MRI, and (3) assessed care delays and impact attributable to MRI.

Methods

We retrospectively compared 66 patients with surgically confirmed acute Achilles ruptures and preoperative MRI with a control group of 66 patients without preoperative MRI. Clinical diagnostic criteria were an abnormal Thompson test, decreased resting tension, and palpable defect. Time to diagnosis and surgical procedures were compared with those of the control group.

Results

All patients had all three clinical findings preoperatively and complete ruptures intraoperatively (sensitivity of 100%). MR images were read as complete tears in 60, partial in four, and inconclusive in two patients. It took a mean of 5.1 days to obtain MRI after the injury, 8.8 days for initial evaluation, and 12.4 days for surgical intervention. In the control group, initial evaluation occurred at 2.5 days and surgical intervention at 5.6 days after injury. Nineteen patients in the MRI group had additional procedures whereas none of the control group patients had additional procedures.

Conclusions

Physical examination findings were more sensitive than MRI. MRI is time consuming, expensive, and can lead to treatment delays. Clinicians should rely on the history and physical examination for accurate diagnosis and reserve MRI for ambiguous presentations and subacute or chronic injuries for preoperative planning.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Achilles Tendon Plantar Flexion Physical Examination Finding Clinical Diagnostic Criterion Complete Rupture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Cetti R, Andersen I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Orthop Relat Res. 1993;286:215–221.PubMedGoogle Scholar
  2. 2.
    Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH 3rd, Turkelson CM, Wies JL, Hitchcock K, Raymond L, Anderson S, Boyer K, Sluka P; American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am. 2010;92:2466–2468.PubMedGoogle Scholar
  3. 3.
    Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH 3rd, Turkelson CM, Wies JL, Raymond L, Anderson S, Boyer K, Sluka P; American Academy of Orthopaedic Surgeons. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:503–510.PubMedGoogle Scholar
  4. 4.
    Chiodo CP, Wilson MG. Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 2006;27:305–313.PubMedGoogle Scholar
  5. 5.
    Den Hartog BD. Surgical strategies: delayed diagnosis or neglected achilles’ tendon ruptures. Foot Ankle Int. 2008;29:456–463.CrossRefGoogle Scholar
  6. 6.
    el-Khoury GY, Brandser EA, Saltzman CL. MRI of tendon injuries. Iowa Orthop J. 1994;14:65–80.PubMedGoogle Scholar
  7. 7.
    Gabel S, Manoli A 2nd. Neglected rupture of the Achilles tendon. Foot Ankle Int. 1994;15:512–517.PubMedGoogle Scholar
  8. 8.
    Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 2: achilles tendon disorders. Am J Sports Med. 2009;37:1223–1234.PubMedCrossRefGoogle Scholar
  9. 9.
    Kou J. AAOS Clinical Practice Guideline: acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:511–513.PubMedGoogle Scholar
  10. 10.
    Krahe MA, Berlet GC. Achilles tendon ruptures, re rupture with revision surgery, tendinosis, and insertional disease. Foot Ankle Clin. 2009;14:247–275.PubMedCrossRefGoogle Scholar
  11. 11.
    Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277–279.PubMedCrossRefGoogle Scholar
  12. 12.
    Longo UG, Ronga M, Maffulli N. Acute ruptures of the achilles tendon. Sports Med Arthrosc. 2009;17:127–138.PubMedCrossRefGoogle Scholar
  13. 13.
    Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon: a prospective study in 174 patients. Am J Sports Med. 1998;26:266–270.PubMedGoogle Scholar
  14. 14.
    Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am. 2008;90:1348–1360.PubMedCrossRefGoogle Scholar
  15. 15.
    Maffulli N, Ajis A, Longo UG, Denaro V. Chronic rupture of tendo Achillis. Foot Ankle Clin. 2007;12:583–596, vi.PubMedCrossRefGoogle Scholar
  16. 16.
    Matles AL. Rupture of the tendo achilles: another diagnostic sign. Bull Hosp Joint Dis. 1975;36:48–51.Google Scholar
  17. 17.
    Movin T, Ryberg A, McBride DJ, Maffulli N. Acute rupture of the Achilles tendon. Foot Ankle Clin. 2005;10:331–356.PubMedCrossRefGoogle Scholar
  18. 18.
    Myerson MS. Achilles tendon ruptures. Instr Course Lect. 1999;48:219–230.PubMedGoogle Scholar
  19. 19.
    Padanilam TG. Chronic Achilles tendon ruptures. Foot Ankle Clin. 2009;14:711–728.PubMedCrossRefGoogle Scholar
  20. 20.
    Popovic N, Lemaire R. Diagnosis and treatment of acute ruptures of the Achilles tendon: current concepts review. Acta Orthop Belg. 1999;65:458–471.PubMedGoogle Scholar
  21. 21.
    Porter DA, Mannarino FP, Snead D, Gabel SJ, Ostrowski M. Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int. 1997;18:557–564.PubMedGoogle Scholar
  22. 22.
    Rajasekar K, Gholve P, Faraj AA, Kosygan KP. A subjective outcome analysis of tendo-Achilles rupture. J Foot Ankle Surg. 2005;44:32–36.PubMedCrossRefGoogle Scholar
  23. 23.
    Reddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KL. Surgical treatment for chronic disease and disorders of the achilles tendon. J Am Acad Orthop Surg. 2009;17:3–14.PubMedGoogle Scholar
  24. 24.
    Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179:56–58.PubMedGoogle Scholar
  25. 25.
    Thompson TC, Doherty JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1962;2:126–129.PubMedCrossRefGoogle Scholar
  26. 26.
    Tocci SL, Madom IA, Bradley MP, Langer PR, DiGiovanni CW. The diagnostic value of MRI in foot and ankle surgery. Foot Ankle Int. 2007;28:166–168.PubMedCrossRefGoogle Scholar
  27. 27.
    Worth N, Ghosh S, Maffulli N. Management of acute Achilles tendon ruptures in the United Kingdom. J Orthop Surg (Hong Kong). 2007;15:311–314.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • David N. Garras
    • 1
  • Steven M. Raikin
    • 2
  • Suneel B. Bhat
    • 1
  • Nicholas Taweel
    • 2
  • Homyar Karanjia
    • 2
  1. 1.Department of Orthopaedic SurgeryThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Foot and Ankle DivisionRothman InstitutePhiladelphiaUSA

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