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Achilles Tendon After Percutaneous Surgical Repair: Serial MRI Observation of Uncomplicated Healing

¹ Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya, Tokyo 154-8532, Japan.
² Department of Orthopedic Surgery, Japan Self-Defense Forces Central Hospital, Tokyo, Japan.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Diagram shows percutaneous surgical repair of Achilles tendon rupture. Six stab incisions, three on medial and three on lateral aspect of tendon, are placed at levels proximal and distal to rupture. Needles and sutures (dashed line) are passed so that sutures are pulled to firmly appose ruptured tendon ends. Contact between two ends of ruptured tendon is incomplete.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2G —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2H —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2I —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2J —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2K —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2L —21-year-old man with ruptured Achilles tendon after percutaneous surgical repair. Serial MR images obtained 28 days (A–D), 57 days (E–H), and 87 days (I–L) after surgery. Disappearance of tendon gap appears earlier on T2-weighted images (A, E, and I) than on T1-weighted images (B, F, and J). Contrast-enhanced T1-weighted images (C, G, and K) show decrease in intratendon enhancement and increase in peritendon enhancement as ring-shaped appearance over time. Sagittal images (D, H, and L) were not used for measurement of gap length because of difficulty measuring precise length.

View larger version (19K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Changes in gap length after percutaneous suture. Dashed line represents gap length changes in cases of rerupture of Achilles tendon during period of observation. Four cases of rerupture of Achilles tendon were excluded from statistical analysis. Graph shows findings on T1-weighted images over time.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Changes in gap length after percutaneous suture. Dashed line represents gap length changes in cases of rerupture of Achilles tendon during period of observation. Four cases of rerupture of Achilles tendon were excluded from statistical analysis. Graph shows findings on T2-weighted images over time.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Proportion of postoperative cases in which gap disappearance was observed after percutaneous suture (n =40) (solid line) and open suture (n =11) (dashed line). Difference between two groups is statistically significant (p < 0.001, log-rank test). Kaplan-Meier graph shows findings on T1-weighted images.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Proportion of postoperative cases in which gap disappearance was observed after percutaneous suture (n =40) (solid line) and open suture (n =11) (dashed line). Difference between two groups is statistically significant (p < 0.001, log-rank test). Kaplan-Meier graph shows findings on T2-weighted images.

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