Does Clinical Exam and Ultrasound Compare With MRI Findings When Assessing Tendon Approximation in Acute Achilles Tendon Tears? A Clinical Study.

The purpose of this study was to determine if clinical palpation and ultrasound determination of apposition compares with magnetic resonance imaging (MRI) findings in patients with an acute Achilles tendon rupture. A review of 18 consecutive patients presenting with an acute Achilles tendon tear was performed. All tears were diagnosed by clinical exam and confirmed by ultrasound. Ankles were then plantarflexed to a point where tendon apposition was achieved as determined by palpation and ultrasound. Dorsally based equinus splints were applied, and approximation was reconfirmed by palpation and ultrasound. MRI was performed on all patients for comparison to the exam/ultrasound for any residual gapping after splinting. Demographic and clinical comparisons were made between those with <0.5 cm and ≥0.5 cm of residual gapping found on MRI. Eighteen patients with acute Achilles tears were splinted at a mean of 41° ± 11°, with presumed, complete tendon approximation confirmed with palpation and ultrasound. Post-splinting MRI demonstrated that 9/18 (50%) of these patients had residual gapping at a mean of 2.2 ± 1 cm. Mean time to MRI from splinting was not different between those with gapping (1.3 ± 2 days) and those without (1.2 ± 1 days). No other clinical or demographic differences were observed between these groups. In conclusion, clinical exam and ultrasound did not routinely relate to MRI in assessing tendon approximation after splinting of an acute Achilles tendon tear. For surgeons who use approximation as a determination of nonoperative treatment, varying results can be obtained depending on the clinical utility used.