What is medical avulsion

Tendon injury

Torn tendon, the connective tissue connection between muscle and bone

Symptoms

Pain, loss of function of a joint, instability

causes

Tendons serve as a link between muscles and bones and are essential for the transmission of force and thus the function of a joint. If the tendon ruptures, this is usually associated with violence. A direct severing can occur in the event of an injury from a sharp object, but more common is the rupture due to sudden overload and overstretching of the tendon. This injury is usually found in athletes or when falling during long (mountain) hikes, where the tendon is already fatigued from the constant stress. Sometimes a tendon breaks spontaneously. However, this is usually based on previous damage, e.g. in the case of rheumatic diseases. With increasing age, there are generally degenerative remodeling processes of the tendons, the susceptibility to tears increases when the impact of violence is already weaker.

diagnosis

The suspicion of a tendon injury usually arises from the mechanism of the accident and the symptoms described by the patient. Sudden pain associated with swelling and bruising is typical. Depending on the localization of the tendon, patients can no longer perform certain movements (loss of function). The doctor can specifically check this in the course of the clinical examination using certain movement sequences and tests. In the case of ruptures of the tendons near the knee joint (quadriceps, patellar tendons), for example, the patient can no longer stretch the affected knee joint independently.
An ultrasound examination (sonography) or magnetic resonance imaging (MRI) is performed to confirm the rupture. With these examinations, tendon tears can be reliably diagnosed. An X-ray is helpful in the case of tears in the tendon ends and to identify accompanying injuries.

Course of disease

Conservative or surgical, depending on the localization of the tendon, age, functional or athletic demands and concomitant diseases.

Secondary illnesses

Permanent loss of function of the affected muscle.

Course of treatment

Treatment of a tendon injury is primarily based on the tendon affected.


Ruptures of the tendons near the knee joint (quadriceps and patellar tendons) usually require surgical treatment. Only in the case of partial tears, when the tendon is still connected, can the treatment be carried out conservatively in a special splint (orthosis). During the operation, the torn tendon is shown by making an incision above (quadriceps tendon) or below (patellar tendon) the kneecap. The quadriceps tendon often tears out at the base of the kneecap. For better stability, the tendon is then "sewn" directly to the bone via drill channels with a special thread (transosseous suture). If the patellar tendon is torn, the tendon stumps are usually sewn directly together. For additional security, a cerclage made of wire (McLaughlin cerclage) or special thread is placed between the kneecap and the tibia to relieve the suture.


The treatment of an Achilles tendon rupture can in certain cases be carried out without surgery (conservative). Certain requirements that must be met are essential. The approach of the stumps in equinus foot position (flexion) is checked in the ultrasound. If there is a good approximation, the patient can be offered conservative therapy. It should also be taken into account here that cracks in the area of ​​the transition from the tendon to the muscle heal better than in the area of ​​the attachment to the heel bone. According to studies, conservative treatment has a slightly increased risk of a new tear (re-rupture). This must be discussed with the patient and should also take his functional requirements (athletes!) Into account. In all other cases, surgery is an option. A distinction is made between open and minimally invasive procedures. Open processes allow the best possible representability and good possibility of direct seam. This is especially important with older ruptures. On the other hand, there is an increased risk of scarring / adhesions and wound healing disorders. Fresh and simple ruptures can therefore be treated with minimally invasive methods. A specially developed device, the Achillon, is used for this. The device is inserted under the skin along the tendon through the smallest possible skin incision, pulling threads through the skin and the tendon ends. These can then be knotted together directly under view.


The rupture of the distal biceps tendon requires surgical therapy. The tendon is then attached to the radial tuberosity (roughness on the part of the
Spoke) attached. Without an operation, there is a considerable loss of strength in the inward rotation and flexion of the forearm. Bone anchors or special suture material (biceps button) can be used to attach the tendon.

Possible complications / risks

Vascular / nerve injury, failure to heal, re-rupture, permanent functional restrictions

Aftercare

Postoperatively, for all of the above-mentioned tendon injuries, it can be assumed that the patient will stay in hospital for several days, during which the physiotherapy will already be started.


In the event of ruptures of the tendons near the knee joint, a functional orthosis is applied during the inpatient stay, which is initially limited to 30 ° of flexion and then released every 2 weeks by a further 30 °. After discharge, there is further outpatient physiotherapeutic treatment and, as a rule, partial exposure for 6 weeks with regular checks by the resident specialist for orthopedics and trauma surgery. The affected leg may be fully loaded with the knee joint extended.


Independent of the therapy (conservative or surgical), Achilles tendons are initially immobilized in a suitable stabilizing boot (e.g. Vacoped) in a 20 ° equinus foot position so as not to strain the seam. In this position, the patient can already put full weight on the affected leg. In the meantime, early functional treatment schemes have proven their worth. The muscles are trained and the tendon is increasingly stretched again.


As a rule, the patients are seen in our consultation hours after 6 weeks and 3 months. The healing is checked in the MRI and sonography. The latest methods such as contrast-enhanced sonography, which makes the blood flow to the sutured tendon visible, are used in clinical studies.


In the case of distal biceps tendon ruptures, rapid and intensive physiotherapeutic treatment is also sought in order to avoid movement restrictions in the elbow. For the first 6 weeks, the patient wears an orthosis with a limitation of the extension, which is released gradually. A full return to physical work and sport is possible after approx. 12 weeks.

Clinical studies and further information

https://www.ncbi.nlm.nih.gov/pubmed

 

Heidelberg Trauma Group

That is what sets us apart

Great experience in the care of tendon injuries using modern procedures, such as stabilization using the BicepsButton or Achillon.