Anatomy of the Achilles tendon


The gastrocnemius-soleus musculotendinous complex is located within the posterior compartment of the calf. The two heads of the gastrocnemius merge together with soleus to form the Achilles tendon. Normal gait relies upon the integrity of the Achilles tendon, and injuries may lead to severe impairments. The tendon receives a load stress up to several times the body weight during walking, and the load stress is amplified by running or jumping. This leaves the Achilles tendon vulnerable to ruptures, especially when exposed to sudden and severe loads, which often occurs during sprinting and racket sports. Men are more prone to injuries compared to women, and changes in sport and leisure activities is commonly perceived as one of the most important factors causing the increased incidence observed during the past decades 1.

Anatomy of the Achilles tendon

Function of the Achilles tendon

A brief reflection on healing


Mechanical loading stimulates bone healing and bone formation. This correlation was deduced by the German surgeon Julius Wolff during the late eighteen century and has later been known as Wolff’s law. Similar to the relationship dictated by Wolff’s law, mechanical loading of tendons stimulates increased tensile strength over time 2 , 3. Awareness centered on this biomechanical trait has led to the development of new rehabilitation protocols, especially concerning non-operative treatment. In analogue to Woffs law, by allowing early controlled loading of the ruptured Achilles tendon, the presumed healing process is accelerated thereby increasing tensile strength 4. If true, this approach would reduce the risk of re-ruptures, and several recent papers have shown that early mobilization actually do improve treatment results. 5. This is of importance since surgery carries the risk of infections and injuries to the surreal nerve. However, the studies carried out this far have included a relatively small number of patients and no firm conclusions have been made. It is therefor of great interest to conclusively determine treatment results by conducting a prospective randomized study comprising a sufficient number of patients, potentially altering current treatment recommendations.

Treatment


A rupture of the Achilles tendon can be treated with surgical repair or by immobilization using a cast or protective boot. Most patients in Norway are treated with surgical repair, which is in contrast to the other Nordic countries. The disadvantages of surgery are risks of wound problems and nerve injuries. However, aspirations to reduce these risks, have led to the development of less invasive surgical techniques. In the Achilles study, we use Dresden instruments developed at the University Hospital in Dresden by Dr. Michael Amlang and colleagues. Dr. Amlang has published promising results 6, and he has also visited Ahus University Hospital to teach his new procedure.

Animation describing open surgical repair

Video describing open surgical repair. Please be advised that this video contains actual surgical procedures.

Animation describing mini-invasive surgical repair

Video describing mini-invasive surgical repair. Please be advised that this video contains actual surgical procedures.