The Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approximately 20% of all large tendon ruptures. Spontaneous rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life and is twice as common in males. It usually occurs following high-performance activities. The authors report a case of unusual presentation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors. In the case presented, nonoperative treatment led to a successful outcome.
Level of Evidence: Therapeutic, Level IV, retrospective case study
Haines JFBilateral rupture of the Achilles tendon in patients on steroid therapy . Ann Rheum Dis. 1983;42:652-654.
2.
Inglis AE, Scott WN, Sculco TP et al. Ruptures of the tendo achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg Am. 1976;58:990-993.
3.
Leadbetter WBCell-matrix response in tendon injury. Clin Sports Med. 1992;11:533-578.
4.
Thompson T., Doherty J.Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test . J Trauma. 1962;2:126-129.
Jozsa L., Kannus P.Histopathological findings in spontaneous tendon rupture. Scand J Med Sci Sports. 1997;7:113-118.
7.
Simoneau GG, Derr JA, Ulbrecht JS, Becker MB, Cavanagh PRDiabetic sensory neuropathy effect on ankle joint movement perception . Arch Phys Med Rehabil. 1996;77:453-460.
8.
Bressel E., Larsen BT, McNair PJ, Cronin J.Ankle joint proprioception and passive mechanical properties of the calf muscles after an Achilles tendon rupture: a comparison with matched controls . Clin Biomech (Bristol, Avon). 2004;19:284-291.
9.
Maffulli N., Tallon C., Wong J., Peng Lim K., Bleakney R.No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness . 2003;43:367-379.
10.
Lee HBAvulsion and rupture of the tendo calcaneus after injection of hydrocortisone . Br Med J. 1957;2:395.
11.
Battista V. , Combs J., Warme WJAsynchronous bilateral Achilles tendon ruptures and androstenediol use. Am J Sports Med. 2003 ;31:1007-1009.
12.
Zabraniecki L., Negrier I., Vergne P., et al. Flouroquinolone induced tendinopathy: report of 6 cases. J Rheumatol. 1996;23:516-520.
13.
Casparian JM , Luchi M., Moffat RE, Hinthorn D.Quinolones and tendon ruptures. South Med J. 2000;93:488-491.
14.
Hestin D., Mainard D., Pere P., et al. Spontaneous bilateral rupture of the Achilles tendons in renal transplant recipients. Nephron. 1993;65:491-492.
15.
Lotem M., Berheim J., Conforty B.Spontaneous rupture of tendons. A complication of haemodialyzed patients treated for renal failure. Nephron. 1978;21:201-208.
16.
Kannus P., Józsa L.Histopathological changes preceding spontaneous rupture of a tendon . J Bone Joint Surg Am. 1991;73:1507-1525.
17.
Smaill GBBilateral rupture of Achilles tendon. Br Med J. 1961;1:1657.
18.
Lynn TARepair of the torn Achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am. 1966;48:268-272.
19.
Krackow KA, Thomas SC, Jones LCA new stitch for ligament-tendon fixation. J Bone Joint Surg Am. 1986;68:764-766.
20.
Teuffer APTraumatic rupture of the Achilles tendon: reconstruction by transplant and graft using the lateral peroneus brevis. Orthop Clin North Am. 1974;5:89-93.
21.
Bradley JP, Tibone JEPercutaneous and open surgical repairs of Achilles tendon ruptures . A comparative study. Am J Sports Med. 1990;18:188-195.
22.
Lim J., Dalal R., Waseem M.Percutaneous vs. open repair of the ruptured Achilles tendon-a prospective randomized controlled study. Foot Ankle Int.2001;22:559-568.
23.
Aktas S., Kocaoglu B.Open versus minimal invasive repair with Achillon device. Foot Ankle Int. 2009;30:391-397.
24.
Calder JD, Saxby TSIndependent evaluation of a recently described Achilles tendon repair technique . Foot Ankle Int. 2006;27:93-96.
25.
Metz R., Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing-a randomized controlled trial. Am J Sports Med. 2008;36:1688-1694.
26.
Khan RJ, Carey Smith RLSurgical interventions for treating acute Achilles tendon ruptures . Cochrane Database Syst Rev.2010;(9):CD003674.
27.
Twaddle BC, Poon P.Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007;35:2033-2038.
28.
Wallace RG, Traynor IE, Kernohan WG, Eames MHCombined conservative and orthotic management of acute ruptures of the Achilles tendon. J Bone Joint Surg Am. 2004;86:1198-1202.
29.
Costa ML, MacMillan K., Halliday D., et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg Br. 2006;88:69-77.
30.
Hufner TM, Brandes DB, Thermann H., Richter M., Knobloch K., Krettek C.Long-term results after functional nonoperative treatment of Achilles tendon rupture. Foot Ankle Int. 2006;27:167-171.
31.
Ingvar J., Tägil M., Eneroth M.Nonoperative treatment of Achilles tendon rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop. 2005 ;76:597-601.
32.
Josey RA, Marymont JV, Varner KE, Borom A., O’Connor D., Oates JCImmediate, full weigthbearing cast treatment of acute Achilles tendon ruptures: a long-term follow-up study. Foot Ankle Int. 2003;24:775-779.
33.
Wallace RGH , Traynor IER, Kernohan WG, Eames MHA.Combined conservative and orthotic management of acute ruptures of the Achilles tendon . J Bone Joint Surg Am. 2004;86:1198-1202.
34.
Weber M., Niemann M., Lanz R., Müller T.Nonoperative treatment of acute rupture of the Achilles tendon. Results of a new protocol and comparison with operative treatment. Am J Sports Med.2003;31:685-691.
35.
Saleh M., Marshall PD, Senior R., MacFarlane A.The SheYeld splint for controlled early mobilisation after rupture of the calcaneal tendon. A prospective, randomised comparison with plaster treatment . J Bone Joint Surg Br.1992;74:206-209.
36.
McComis GP, Nawoczenski DA, DeHaven KEFunctional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg Am.1997;79:1799-1808.
37.
Roberts CP, Palmer S., Vince A., Deliss LJDynamised cast management of Achilles tendon ruptures. Injury . 2001;32:423-426. 38. Kitaoka HB, Crevoisier XM, Harbst K., Hansen D., Kotajarvi B., Kaufman K.The effect of custom-made braces for the ankle and the foot kinematics and ground reaction forces. Arch Phys Med Rehabil. 2006;87:130-135.
38.
Möller M., Movin T., Granhed H., Lind K., Faxén E., Karlsson J.Acute rupture of tendo Achillis. A prospective, randomised study of comparison between surgical and non-surgical treatment . J Bone Joint Surg Br.2001;83:843-848.
39.
Calder JD, Saxby TSEarly, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study. Br J Sports Med. 2005;39:857-859.
40.
Enwemeka CS , Spielholz NI, Nelson AJThe effect of early functional activities on experimentally tenotomized Achilles tendons in rats . Am J Phys Med Rehabil. 1988;67:264-269.
41.
Gelbermann RH, Menon J., Gonsalves M., Akeson WHThe effects of mobilization on the vascularization of healing flexor tendons in dogs. Clin Orthop. 1980;153:283-289.
42.
Palmes D., Spiegel HU, Schneider TO, et al. Achilles tendon healing: long-term biomechanical effects of postoperative mobilization and immobilisation in a new mouse model. J Orthop Res. 2002;20:939-946.
43.
Tipton CM, Matthes RD, Maynard JA, Carey RAThe influence of physical activity on ligaments and tendons. Med Sci Sports. 1975;7:165-175.
44.
Khan RJK , Fick D., Keogh A., Crawford J., Brammar T., Parker M.Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005 ;87:2202-2210.
45.
Wong J., Barrass V., MaVulli N.Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565-575.
