Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2005 Nov;39(11):838–842. doi: 10.1136/bjsm.2005.018416

Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging

R Kayser 1, K Mahlfeld 1, C Heyde 1, C Tschauner 1
PMCID: PMC1725056  PMID: 16244194

Abstract

Objectives: The aim of this study was to determine whether ultrasound can correctly visualise partial ruptures of the proximal Achilles tendon.

Method: This was a prospective study in which all chronic Achilles tendon injury patients seen at three centres in Germany from 1998 to 2003 were screened. All patients with clinical and/or sonographic signs of abnormalities in the region of the proximal third of the Achilles tendon and tendomuscular junction were included in the analysis. Each of these cases was evaluated by ultrasound following an assessment protocol. Patients with ambiguous ultrasound findings and/or clinical signs were additionally assessed by magnetic resonance imaging (MRI).

Results: Sonomorphologic changes suggestive of an abnormality in the proximal third of the Achilles tendon were detected in 13 out of 320 patients (4.2%) with recurring Achilles tendon complaints. Thirteen patients had clinical signs but no sonographic changes in the tendon. The sonographic diagnosis was correct in 19 cases. In six of the 26 cases studied, MRI was needed to establish the correct diagnosis of partial intratendinous rupture of the proximal Achilles tendon. Sensitivity was 0.5, specificity was 0.81, and the overall agreement of the ultrasound examination was 61.5%. All patients were asymptomatic at follow up at a mean of 14 months (range 12–17 months) after surgery.

Conclusions: Ultrasound is a useful tool for evaluation of proximal Achilles tendon complaints. However, ultrasound is not sufficiently reliable for diagnosis of all pathologies, especially partial ruptures of the Achilles tendon. Thus, the definitive diagnosis must be established by MRI.

Full Text

The Full Text of this article is available as a PDF (173.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brandser E. A., el-Khoury G. Y., Saltzman C. L. Tendon injuries: application of magnetic resonance imaging. Can Assoc Radiol J. 1995 Feb;46(1):9–18. [PubMed] [Google Scholar]
  2. Gibbon W. W., Cooper J. R., Radcliffe G. S. Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis. Br J Sports Med. 1999 Apr;33(2):129–130. doi: 10.1136/bjsm.33.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Jacobson J. A. Musculoskeletal sonography and MR imaging. A role for both imaging methods. Radiol Clin North Am. 1999 Jul;37(4):713–735. doi: 10.1016/s0033-8389(05)70125-1. [DOI] [PubMed] [Google Scholar]
  4. Kainberger F., Engel A., Trattnig S., Pölzleitner D., Kutschera H. P., Seidl G. Sonographische Strukturanalyse der Achillessehne und biomechanische Implikationen. Ultraschall Med. 1992 Feb;13(1):28–30. doi: 10.1055/s-2007-1005271. [DOI] [PubMed] [Google Scholar]
  5. Kainberger F., Fialka V., Breitenseher M., Kritz H., Baldt M., Czerny C., Imhof H. Differentialdiagnose von erkrankungen der Achillessehne. Radiologe. 1996 Jan;36(1):38–46. doi: 10.1007/s001170050037. [DOI] [PubMed] [Google Scholar]
  6. Khan K. M., Forster B. B., Robinson J., Cheong Y., Louis L., Maclean L., Taunton J. E. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med. 2003 Apr;37(2):149–153. doi: 10.1136/bjsm.37.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kälebo P., Allenmark C., Peterson L., Swärd L. Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon. Am J Sports Med. 1992 Jul-Aug;20(4):378–381. doi: 10.1177/036354659202000402. [DOI] [PubMed] [Google Scholar]
  8. Kälebo P., Goksör L. A., Swärd L., Peterson L. Soft-tissue radiography, computed tomography, and ultrasonography of partial Achilles tendon ruptures. Acta Radiol. 1990 Nov;31(6):565–570. [PubMed] [Google Scholar]
  9. Lehtinen A., Peltokallio P., Taavitsainen M. Sonography of Achilles tendon correlated to operative findings. Ann Chir Gynaecol. 1994;83(4):322–327. [PubMed] [Google Scholar]
  10. Mahlfeld K., Kayser R., Mahlfeld A., Grasshoff H., Franke J. Wert der Sonographie in der Diagnostik von Bursopathien im Bereich der Achillessehne. Ultraschall Med. 2001 Apr;22(2):87–90. doi: 10.1055/s-2001-12854. [DOI] [PubMed] [Google Scholar]
  11. Majewski M., Lehmann M., Dick W., Steinbrück K. Wertigkeit der sonographischen Verlaufskontrolle nach Achillessehnenrupturbehandlung--Vergleich konservative Therapie, perkutane und offene Naht. Unfallchirurg. 2003 Jul;106(7):556–560. doi: 10.1007/s00113-003-0623-8. [DOI] [PubMed] [Google Scholar]
  12. Merk H. Die hochauflösende Real-Time-Sonographie in der Diagnostik von Achillessehnenerkrankungen. Ultraschall Med. 1989 Aug;10(4):192–197. doi: 10.1055/s-2007-1005989. [DOI] [PubMed] [Google Scholar]
  13. Movin T., Kristoffersen-Wiberg M., Rolf C., Aspelin P. MR imaging in chronic Achilles tendon disorder. Acta Radiol. 1998 Mar;39(2):126–132. doi: 10.1080/02841859809172165. [DOI] [PubMed] [Google Scholar]
  14. Movin T., Kristoffersen-Wiberg M., Shalabi A., Gad A., Aspelin P., Rolf C. Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in chronic achillodynia. Foot Ankle Int. 1998 May;19(5):311–317. doi: 10.1177/107110079801900508. [DOI] [PubMed] [Google Scholar]
  15. Nehrer S., Breitenseher M., Brodner W., Kainberger F., Fellinger E. J., Engel A., Imhof F. Clinical and sonographic evaluation of the risk of rupture in the Achilles tendon. Arch Orthop Trauma Surg. 1997;116(1-2):14–18. doi: 10.1007/BF00434093. [DOI] [PubMed] [Google Scholar]
  16. Paavola M., Kannus P., Paakkala T., Pasanen M., Järvinen M. Long-term prognosis of patients with achilles tendinopathy. An observational 8-year follow-up study. Am J Sports Med. 2000 Sep-Oct;28(5):634–642. doi: 10.1177/03635465000280050301. [DOI] [PubMed] [Google Scholar]
  17. Reicher M. A., Bassett L. W., Gold R. H. High-resolution magnetic resonance imaging of the knee joint: pathologic correlations. AJR Am J Roentgenol. 1985 Nov;145(5):903–909. doi: 10.2214/ajr.145.5.903. [DOI] [PubMed] [Google Scholar]
  18. Rupp S., Tempelhof S., Fritsch E. Ultrasound of the Achilles tendon after surgical repair: morphology and function. Br J Radiol. 1995 May;68(809):454–458. doi: 10.1259/0007-1285-68-809-454. [DOI] [PubMed] [Google Scholar]
  19. Segesser B., Goesele A., Renggli P. Die Achillessehne im Sport. Orthopade. 1995 Jun;24(3):252–267. [PubMed] [Google Scholar]
  20. Sell S., Schulz R., Balentsiefen M., Weber H., Küsswetter W. Lesions of the Achilles tendon. A sonographic, biomechanical and histological study. Arch Orthop Trauma Surg. 1996;115(1):28–32. doi: 10.1007/BF00453213. [DOI] [PubMed] [Google Scholar]
  21. Williams J. G. Achilles tendon lesions in sport. Sports Med. 1986 Mar-Apr;3(2):114–135. doi: 10.2165/00007256-198603020-00003. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES