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E2471. USG Spectrum of Achilles Tendon Injuries
Authors
  1. Bhanupriya Singh; Lohia Institute of Medical Sciences
Objective:
Ultrasound diagnosis of achilles tendon tears. Distinguishing partial tears from complete tears.

Materials and Methods:
Achilles tendon is scanned by high frequency linear transducer probe. We performed USG with ge logiq s8 USG machine. Patient is placed in prone position with dorsiflexion at the ankle joint. Tendon is scanned in its entirety in longitudinal and transverse sections. Distal part of calf muscles should also be scanned. A metal clip is used to locate the ends of the tear with impressions of clip as markers to locate the tear ends. Dynamic assessment is useful in assessment of tear diagnosis.

Results:
Ultrasound is the first imaging choice for diagnosis of achilles tendon pathologies and provides high resolution of fibrillar achilles tendon besides dynamic assessment of achilles tendon. Achilles tendon is the largest tendon in our body, originating in the midcalf at the junction of two heads of gastrocnemius muscle and soleus muscle and inserts onto the back of calcaneal tuberosity. Achilles tendon can be easily assessed by ultrasound and can be seen as rounded linear structure inserting on calcaneal tuberosity with its fibrillar appearance.

Conclusion:
Achilles tendon is formed by union of two heads of gastrocnemius and soleus muscle in midcalf region and inserts on calcaneal tuberosity. It is the largest tendon in our body and is prone to degeneration making it susceptible to tears. Achilles tendon is superficially located and can be easily examined by clinical examination, USG and MRI. USG is the first choice for evaluation of achilles tendon tears and can differentiate between degeneration, partial and complete tears. USG is noninvasive with no issues of radiation exposure and dynamic evaluation of tendon is possible in real time. Achilles tendon injuries can be easily scanned by USG in longitudinal and transverse views with linear probes. Achilles tendon tears can be partial or complete type with complete type more common than partial type. Partial tears have some intacts fibres. Complete tears have full thicknees disruption with retracted torn edges. Retracted edges show edge artifact with posterior acoustic shadowing. Length between the torn edges should be measured as it has the bearing on management of the patients. Anechoic or heterogenous blood can interpose between torn edges. Plantaris tendon can interpose in tear gap and should not be misdiagnosed as partial thickness tendon tear. Dynamic scanning with plantar flexion and dorsiflexion at the ankle joint can help in differentiation between degeneration, partial and complete tears.