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Gastrocnemius tendon avulsion

ISSN 2398-2950


Introduction

  • Avulsion from calcaneus with/without intact superficial digital flexor tendon.
  • Signs: variable hyperflexion of hock and digits - may become bilateral; may not present as acute injury - marked tendon thickening common.
  • Treatment: hold hock in extension +/- surgical repair/resection and repair.

Presenting signs

  • Acute or chronic hindlimb lameness.
  • Variable hyperflexion of hock and digits.
  • Marked tendon thickening - more chronic condition.

Acute presentation

  • Acute onset hindlimb lameness.
  • Variable hyperflexion of hock and digits.

Pathogenesis

Etiology

  • Trauma.

Diagnosis

Presenting problems

  • Hindlimb lameness.

Client history

  • Acute or chronic hindlimb lameness.

Clinical signs

  • Varying degrees of hyperflexion of hock and digits  Gastrocnemius tendon rupture 02: plantigrade stance .
  • Marked tendon thickening.

Diagnostic investigation

Radiography

  • See Radiography: tarsus and hindfoot Radiography: tarsus and hindfoot.
  • Soft tissue thickening of distal gastrocnemius .
  • Variable dystrophic calcification within soft tissue, proliferative new bone on tuber calcanei - more chronic condition.
  • Enthesiophyte on plantodistal border of calcaneus , especially proximal and plantar aspects.

Ultrasonography

Confirmation of diagnosis

Discriminatory diagnostic features

  • Clinical signs.

Definitive diagnostic features

  • Radiographic findings.
  • Ultrasonographic findings .

Treatment

Standard treatment

Acute injury

Chronic injury

  • Rest tendon by placement of bone screw from calcaneus to tibia and leave in for 6-8 weeks +/- tendon sutures (secondary option).
  • Tendon shortening by resection and reanastomosis, especially if marked plantigrade stance.
  • Tendon suture may be anchored through a bone tunnel in the calcaneus if little tendon tissue is present distally for reattachment.

Subsequent management

Treatment

Prevention

Outcomes

Prognosis

  • Generally good.

Reasons for treatment failure

  • Conservative treatment generally ineffective.

Further Reading

Publications

Refereed papers