J Korean Foot Ankle Soc.  2023 Jun;27(2):39-42. 10.14193/jkfas.2023.27.2.39.

Achilles Tendon Sleeve Avulsion

• Lee W
• Jeong J
• Min B
• Yeo E

• KMID: 2542998
• DOI: http://doi.org/10.14193/jkfas.2023.27.2.39

Abstract

A ruptured Achilles tendon at the calcaneus attachment, which does not include a bone that can be fixed, is called “sleeve avulsion”. A small amount of tendon in the calcaneal region can be sutured to the proximal portion of the ruptured Achilles tendon or insufficient bone to be fixed. Hence, tendon-bone healing is expected, but the results are not good compared to other parts of the tear. The incidence of Achilles tendon rupture is 7 to 40 per 100,000 patients, and 25% of patients undergo direct suture or reconstruction surgery, and 7.6% of patients with sleeve avulsion injuries undergo surgery. Surgical treatment may be a better choice for Achilles tendon sleeve avulsion because no successful case of conservative treatment has been reported. Distal wounds above the ruptured tendon adjacent to the bony eminence can have wound healing problems because of the thin, soft tissue and hypovascularity. An appropriate surgical method must be selected for each patient.

Keyword

Achilles tendon; Fracture; Avulsion; Sutures

Figure

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  Figure 1 This illustration shows classification of avulsion fracture of the calcaneal tuberosity. (A) Type I: simple extra-articular avulsion; (B) Type II: beak fracture with an oblique fracture from behind Bohler’s angle; (C) Type III: infrabursal avulsion involving superficial fibers of Achilles tendon; (D) Type IV: beak, but a small triangular fragment involving deep fibers of Achilles tendon.

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  Figure 2 This illustration shows tendon fixation at the tendon-bone interface. (A) Transcalcaneal tunnel; (B) suture anchor fixation.

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