Acute Sports Injuries - TENDON TEAR/RUPTURE

Tendons connect muscle to bone and function to transmit muscle contractile forces necessary for motion. They consist of parallel collagen fibres that are more tightly packed than in ligaments, which allow tendons to resist tensile loading. The tensile strength of tendon is so great that acute tear or rupture of a normal, healthy tendon is relatively rare, with forces more likely to cause an avulsion fracture or failure at the musculotendinous junction (e.g. muscle strain).

Tendons that do acutely fail usually have some form of underlying pathology such as tendinosis. This is usually asymptomatic, such that the tendon failure appears to occur without warning. As the presence of pathology increases with age, tendon ruptures most frequently occur in middle-aged and older athletes. The two most commonly ruptured tendons are the Achilles and supraspinatus tendons, with ruptures involving either a portion (partial) or the full thickness (complete).

Partial ruptures are characterised by the sudden onset of pain, localised tenderness and a loss of tendon function that is inversely related to the size of the tear. In contrast, complete ruptures are associated with a total loss of tendon function and acute pain, but the pain often settles quickly due to concomitant damage of nociceptor afferents.

Diagnosis of tendon ruptures can be confirmed using imaging, with both ultrasonography and magnetic resonance imaging being useful at distinguishing between partial and complete ruptures. Partial tendon ruptures may be managed conservatively using progressive rehabilitation; however, complete ruptures may be treated by surgical repair to restore tendon continuity and function, followed by rehabilitation.

REFERENCES

Brukner, P., 2012. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.