CLINICAL AND SONOGRAPHIC EVALUATION OF THE RISK OF RUPTURE IN THE ACHILLES-TENDON

Chronic pain in the region of the Achilles tendon is a common problem and often a sign of progressive degeneration of the tendon which may l ead to its rupture, We studied the clinical course and sonograms in 36 patients with achillodynia to find a prognostic parameter enabling us to estimate the risk of rupture, The patients were evaluated clinical ly for swelling and tenderness and by high-resolution real-time sonogr aphy. The sonograms were graded according to the tendon thickness as n ormal (< 6 mm), minimal (6-8 mm), moderate (8-10 mm) to high-grade (> 10 mm) in the sagittal diameter of the transverse section, and alterat ions of echotexture were described as diffuse, circumscribed, or inhom ogenous. At the time of the primary investigation, we found thickening and alterations of the echotexture in 33 of 72 tendons, In 48 tendons we found pain and local or diffuse swelling in the Achilles tendon re gion (sensitivity 0.58, specificity 0.79). After a follow-up of 48 +/- 8 months, 7 tendons had ruptured spontaneously. Analysis of the sonog rams of the patients taken prior to the rupture showed a high-grade th ickening in 4 cases, moderate thickening in 2 cases, and a diameter be tween 6 and 8 mm in one patient. In no case did we find a rupture of a tendon primarily classified as normal. Patients without sonographic c hanges exhibited a significantly better clinical outcome following con servative treatment. Sonography was found to be a valuable tool for de termination of the tendon's thickness and echotexture. In 28% of our p atients with thickening, circumscribed lesions of the echotexture, and chronic pain, a spontaneous rupture occurred.