Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Cetti R, Andersen I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Orthop Relat Res. 1993;286:215–221.

    PubMed  Google 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.

    PubMed  Google 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.

    PubMed  Google Scholar 

  4. 4.

    Chiodo CP, Wilson MG. Current concepts review: acute ruptures of the achilles tendon. Foot Ankle Int. 2006;27:305–313.

    PubMed  Google Scholar 

  5. 5.

    Den Hartog BD. Surgical strategies: delayed diagnosis or neglected achilles’ tendon ruptures. Foot Ankle Int. 2008;29:456–463.

    Article  Google Scholar 

  6. 6.

    el-Khoury GY, Brandser EA, Saltzman CL. MRI of tendon injuries. Iowa Orthop J. 1994;14:65–80.

    PubMed  CAS  Google Scholar 

  7. 7.

    Gabel S, Manoli A 2nd. Neglected rupture of the Achilles tendon. Foot Ankle Int. 1994;15:512–517.

    PubMed  CAS  Google 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.

    PubMed  Article  Google Scholar 

  9. 9.

    Kou J. AAOS Clinical Practice Guideline: acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:511–513.

    PubMed  Google 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.

    PubMed  Article  Google Scholar 

  11. 11.

    Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277–279.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Longo UG, Ronga M, Maffulli N. Acute ruptures of the achilles tendon. Sports Med Arthrosc. 2009;17:127–138.

    PubMed  Article  Google 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.

    PubMed  CAS  Google Scholar 

  14. 14.

    Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am. 2008;90:1348–1360.

    PubMed  Article  Google Scholar 

  15. 15.

    Maffulli N, Ajis A, Longo UG, Denaro V. Chronic rupture of tendo Achillis. Foot Ankle Clin. 2007;12:583–596, vi.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  18. 18.

    Myerson MS. Achilles tendon ruptures. Instr Course Lect. 1999;48:219–230.

    PubMed  CAS  Google Scholar 

  19. 19.

    Padanilam TG. Chronic Achilles tendon ruptures. Foot Ankle Clin. 2009;14:711–728.

    PubMed  Article  Google 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.

    PubMed  CAS  Google 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.

    PubMed  CAS  Google 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.

    PubMed  Article  Google 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.

    PubMed  Google Scholar 

  24. 24.

    Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179:56–58.

    PubMed  CAS  Google Scholar 

  25. 25.

    Thompson TC, Doherty JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1962;2:126–129.

    PubMed  Article  CAS  Google 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.

    PubMed  Article  Google 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.

    CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to David N. Garras MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Garras, D.N., Raikin, S.M., Bhat, S.B. et al. MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria. Clin Orthop Relat Res 470, 2268–2273 (2012). https://doi.org/10.1007/s11999-012-2355-y

Download citation

Keywords

  • Achilles Tendon
  • Plantar Flexion
  • Physical Examination Finding
  • Clinical Diagnostic Criterion
  • Complete Rupture