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Die Achillessehnenruptur

Rupture of the Achilles tendon

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Zusammenfassung

Die Achillessehnenruptur ist die häufigste Sehnenruptur des Menschen – mit steigender Inzidenz. Hauptrisikofaktor ist die intrinsische Degeneration der Sehne. Meist wird ein peitschenhieb- oder dolchstichartiger Schmerz verspürt. Es folgen eingeschränkte Gehfähigkeit und eine abgeschwächte Plantarflexionsfähigkeit. Klinisch sind der positive Thompson-/Simmond-Test und eine tastbare Delle über der Ruptur pathognomonisch. Diagnostisch sind eine Sonografie und eine seitliche Röntgenuntersuchung des Fersenbeins (knöcherner Ausriss) notwendig. Mit den meisten etablierten operativen und konservativen Therapieformen sind bei richtiger Indikation und regelrechtem Verlauf optimale funktionelle Ergebnisse möglich. Die operative Therapie zeigt eine bessere Primärstabilität und frühzeitiger etwas bessere funktionelle Ergebnisse, beinhaltet aber immer auch die Gefahr von Komplikationen. Bei konservativer Therapie sind die Raten an Sehnenrerupturen und die Ausheilung in Sehnenelongation höher. Die Behandlung ist individuell auszurichten. Wir empfehlen bei sportlichem Anspruch und einem Alter < 50 Jahren die operative Therapie.

Abstract

The rupture of the Achilles tendon is the most frequent tendon rupture in humans and it is associated with increasing incidence. The main risk factor is intrinsic degeneration of the tendon. During the rupture the person feels a whiplash or dagger thrust-like pain, followed by restricted walking ability and decreased plantar flexion of the ankle. The positive Simmond/Thompson test and a palpable dent above the tendon rupture are pathognomical. Diagnostically, ultrasound of the tendon and lateral x-ray of the calcaneus (bony pull-out of the tendon insertion) are necessary. Regarding correct indication and treatment modalities, most established conservative and surgical therapies realize optimal functional results. Surgical treatment promises better primary stability and slightly earlier better functional results, but there is the potential for surgical complications. Conservative therapy is associated with higher rates of re-rupture and healing of the tendon under elongation. Therefore, therapy planning in Achilles tendon rupture should be determined based on each patient. We recommend surgical treatment in patients with higher sporting demands and in younger patients (< 50 years).

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Ulmar, St. Simon, A. Eschler und Th. Mittlmeier geben an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. RKU, Orthopädisches Universitätsklinikum Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland

    B. Ulmar

  2. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    B. Ulmar, S. Simon, A. Eschler & T. Mittlmeier

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  1. B. Ulmar
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  2. S. Simon
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  3. A. Eschler
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  4. T. Mittlmeier
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Correspondence to B. Ulmar.

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Ulmar, B., Simon, S., Eschler, A. et al. Die Achillessehnenruptur. Unfallchirurg 117, 921–939 (2014). https://doi.org/10.1007/s00113-014-2627-y

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