Three-Bundle Technique

Abstract

For the diagnosis of an Achilles tendon rupture (Fig. 3.1), it is important to inquire about the patients’ history. They may recall a loud ‘snapping’ sound and a short stab of pain that may be experienced as a kick in the area of the Achilles tendon [4]. On physical examination the course of the Achilles tendon may be visibly and palpably interrupted by indentation. A few hours after the trauma, the gap, however, may be invisible due to swelling and due to a haematoma and oedema. In case of a positive calf squeeze test, a total rupture is indicated [13]. Additional diagnostics may consist of roentgenography (x-ray), ultrasonography (US) and magnetic resonance imaging (MRI). Active patients should be offered both conservative and surgical treatment. Athletes most often are offered the surgical treatment option. It has advantages over conservative treatment, especially in athletes, as it allows early mechanical loading in an accelerated rehabilitation protocol [10]. The three-bundle technique is preferred in the acute situation as the preinjury tendon length can be achieved, allowing re-establishment of maximum isokinetic strength of the Achilles tendon, and can bear a higher load after surgery compared to other techniques like the Krakow locking loop technique [3]. Compared to conservative treatment, immobilization time is reduced, safe early return to weight-bearing is allowed, and risk of re-rupture is diminished [2].