CASE REPORT   

Medicina dello Sport 2022 June;75(2):315-26

DOI: 10.23736/S0025-7826.22.04073-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English, Italian

Achilles tendon sleeve avulsion following open repair of a ruptured Achilles tendon

Milankov VUKADIN ¹ ✉, Bjelobrk MILE ², Ninkovic SRDJAN ²

¹ Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; ² Clinical Center of Vojvodina, Novi Sad, Serbia

Recurrent Achilles tendon ruptures, or “re-ruptures,” occur at the site of a previous Achilles tendon rupture and are uncommon. Recurrent ruptures occurring either proximal or distal to the first rupture are called “second ruptures” and are even more uncommon. Achilles tendon sleeve avulsions constitute 2.6% of all primary Achilles tendon ruptures. However, avulsions that occur as “second ruptures” are rare, and there have been no reports of avulsions that occur both as second ruptures and without bone fragments. We present the case of a 33-year-old male professional basketball player who suffered a “second rupture” in the form of an Achilles tendon sleeve avulsion, 3 years after an open repair of a midsubstance Achilles tendon rupture. The diagnosis was made preoperatively using MRI, which showed an Achilles tendon sleeve avulsion without an attached bone fragment. We used 3 suture anchors to achieve a firm fixation of the tendon to the calcaneus, after refreshing the original tendon insertion site on the calcaneus. After surgery, the patient underwent cautious functional rehabilitation. Ten months later, he was able to fully resume his regular activity as a professional basketball player. This case is an example of a unique “second” Achilles tendon sleeve avulsion, likely the result of insertional tendinosis, diagnosed preoperatively by MRI, and repaired successfully using suture anchor fixation.

KEY WORDS: Tendinopathy; Athletic injuries; Suture anchors; Therapeutics