Abstract:
Introduction. Acute injury of Achilles tendon represents 20% from large tendon ruptures and the incidence
is 11-37 per 100 thousand people (by Park et al. 2020).
Case presentation. A 43-year-old man, after a sprint, heard a crack and a sharp pain in his right ankle, on
the posterior part a day ago. He went directly to the Clinical Hospital of Traumatology and Orthopedics.
He was clinically examined where it was determined swelling of the ankle region and 1/3 of the lower back
of the right leg, erasing the Achilian contour, the foot is moved sideways. Palpation of the Achilles tendon
diastase. Thomson sign - positive on the right. The sonographic examination determined the Achilles tendon
tears with a diastase of 4 cm. The patient was recommended surgery to repair the rupture of the Achilles
tendon by percutaneous tenorrhaphy. An informed agreement was obtained after explication of the risks
and benefits of the surgical treatment. Surgery was made with spinal anesthesia and fixing sterile zone, the
distal and proximal ends of the Achilles tendon were drawn with a sterile marker from the visually
determined and palpable injury on the skin. Percutaneous sutures were applied after Cuneo in two rows at
the proximal end and one row at the distal end, through two mini-incisions, the opposite ends were adapted
on the lateral and medial edge, the foot in the equine (hyperflexion), thus the final ligation of the threads
was achieved. Applying the dressing. The final step is followed by the application of the leg immobilization
with the foot in the equine on the right. Simple evolution of the postoperative period. After 6 weeks of
immobilization, the patient starts rehabilitation.
Discussion. Fresh Achilles tendon injury needs to be diagnosed primarily as early as possible, with the use
of sonographic examination to confirm the clinical diagnosis allowing us to perform minimally invasive
treatment such as percutaneous tenorrhaphy.
Conclusion. Achilles tendon is the largest and strongest tendon of the human body and its usual injury is
caused by recreational activity. Early establishing the diagnosis of Achilles tendon injury permitted primary
repairing this anatomical structure by minimally invasive technique.
