[Achilles tendon rupture. Anamnestic and morphologic studies and considerations on the etiology]

From 1. October 1985 to 31. December 1987 93 patients (82 male, 11 female) with rupture of the achillestendon were investigated by means of a questionnaire, the specimens obtained at operation were examined histologically. In two cases the operation was for a rerupture of the tendon, 7 and 8 weeks respectively after the first operation. In 6 cases a rupture followed a so-called incomplete rupture on the same side. 9 patients had had a tendonrupture of the other side between 2.5 and 10 years previously. 85.4% of the ruptures took place during a sporting activity. Of the 93 patients 55 (59%) regularly took part in long term sporting activities. Symptoms in the area of one or both achilles tendons were experienced by 32% of the patients. 80 patients with an achilles tendon rupture who were operated within 10 days demonstrated structural degeneration of at least moderate proportions, mostly severe or very severe (there was no relationship between the degree of degeneration and the age of the rupture). The signs of repair were consistent with the age of the rupture. In 56% of the ruptures up to four days old the repair process was considerably more advanced than the age of the rupture would suggest. 6 of 10 patients with the so-called "Archillodynie" demonstrated minor changes although 3 had more severe degenerative changes. Our inquiry clearly demonstrates that structural changes in the tendon took place before the injury. In the cases of achilles tendon rupture the processes of repair are an-adequate to compensate for the degenerative changes. The etiology of the structural degenerations is dependent on many endogenous and exogenous factors particularly the inadequacy of the repair processes.