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Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis
  1. Håkan Alfredson1,*,
  2. Lorenzo Masci2,
  3. lars Öhberg3
  1. 1 Sports medicine Unit, University of Umeå, Sweden;
  2. 2 Pure Sports Medicine, London, United Kingdom;
  3. 3 Department of Radiology, Umeå, Sweden
  1. Correspondence to: Hakan Alfredson, Department of Surgical and Perioperative Scie, Umea University, Orthopaedic Surgeon, Associate Professor Sports Medicine Unit, Umea University, Department of Surgical and Perioperative Sciences, Umea, 901 87, Sweden; hakan.alfredson{at}


Background: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain, and/or relative weakness in plantar flexion force, are indicators. The most loaded side of the Achilles tendon is the dorsal side (skin side). Objective: To evaluate the ultrasound (US) and Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon.

Material and Methods: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71) were examined clinically and by US+CD because of midportion Achilles tendon pain. There was an acute onset in 14/17 patients, and all had painful weakness during tendon loading activity.

Results: In all patients the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the ultrasound findings, showing disruption on the dorsal side, and a partial rupture in the dorsal and mid- tendon.

Conclusions: Ultrasound and Doppler examination can be helpful tools to diagnose partial midportion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line, and high blood flow in the structurally abnormal dorsal tendon, indicate a partial rupture.

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