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World J Orthop. Apr 18, 2021; 12(4): 207-213
Published online Apr 18, 2021. doi: 10.5312/wjo.v12.i4.207
Fracture of ossified Achilles tendons: A review of cases
Hisatoshi Ishikura, Naoshi Fukui, Mitsuyasu Iwasawa, Satoru Ohashi, Takeyuki Tanaka, Sakae Tanaka
Hisatoshi Ishikura, Takeyuki Tanaka, Sakae Tanaka, Department of Orthopedic Surgery, University of Tokyo, Tokyo 113-8655, Bunkyo-ku, Japan
Naoshi Fukui, Mitsuyasu Iwasawa, Satoru Ohashi, Department of Orthopedic Surgery, National Hospital Organization, Sagamihara Hospital, Sagamihara 252-0392, Kanagawa Prefecture, Japan
Author contributions: Ishikura H wrote the paper; Fukui N, Iwasawa M, Ohashi S, Tanaka T and Tanaka S collected the previous reports; all authors made the revisions for the first draft and also approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hisatoshi Ishikura, MD, Doctor, Department of Orthopedic Surgery, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Bunkyo-ku, Japan. hishikura817@gmail.com
Received: January 2, 2021
Peer-review started: January 2, 2021
First decision: January 18, 2021
Revised: January 27, 2021
Accepted: March 8, 2021
Article in press: March 8, 2021
Published online: April 18, 2021
Processing time: 100 Days and 4.2 Hours
Abstract

Fracture of an ossification of the Achilles tendon (OAT) is a rare entity, and its etiology, pathology, and treatment remain unclear. We reviewed and scrutinized 18 cases (16 articles) of the fracture of an OAT. The most common etiologies of the ossifications include previous surgery and trauma. The fractures often occur without any trigger or with minimal trigger. The long, > 5 cm, ossification in the body of the Achilles tendon may have a higher risk of fracture. The OAT itself is often asymptomatic; however, its fracture causes severe local pain, swelling, and weakness of plantar flexion, which forces patients to undergo aggressive treatments. Regarding the treatments of the fractures, nonoperative treatment by immobilizing ankle joint could be an option for elderly patients. However, because it often cannot produce satisfactory results in younger patients, surgical treatment is typically recommended. Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough. If there is a defect after the excision, reconstruction with autologous grafts or adjacent tendon transfer is performed. Gastrocnemius fascia turndown flap, hamstring tendon and tensor fascia lata are used as autologous grafts, whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer. If the fracture of an OAT is treated properly, the functional result will be satisfactory.

Keywords: Achilles tendon; Ossification; Fracture; Tissue grafting; Tendon transfer; Treatment

Core Tip: This review paper aims to provide an overview of the fracture of an ossification of the Achilles tendon. This fracture is distinct in that it occurs with minimal or no triggers. Nonoperative treatments may offer acceptable results for the elderly; however, surgeries should be recommended in younger patients. Following excision of the fractured mass, repairing the tendon is only applicable if the remnant is enough. If there is a defect after the excision, reconstruction with autografts or adjacent tendon transfer is performed. Various kinds of tissues are used for the reconstruction. Treated properly, the functional result will be satisfactory.