Computed radiography and MRI evaluation of a novel functional brace for conservative treatment of subcutaneous Achilles tendon rupture

A total of 267 patients were conservatively treated using novel functional braces. In 34 patients, we observed healing process of the Achilles tendon in a series of magnetic resonance (MR) and computed radiogram (CR) images. CR images were taken periodically, while MR images were obtained at onset of injury and 3 to 4 weeks, 9 to 10 weeks, and 4 to 5 months after injury. We assessed the morphology of the ruptured tendon section by observing intensity changes in the periodic MR examinations. During early conservative therapy (3 to 4 weeks), dumbbell-shaped tendons were most common. At 9 to 10 weeks (i.e., when the brace was removed), tendon continuity was observed at the rupture site; the average antero-posterior tendon diameter was 8.5 mm. Most areas were of low signal intensity, although some areas of moderate signal intensity remained. The tendons of 22 patients had an hourglass shape, while those of 12 patients were spindle shaped. Four to 5 months after injury (i.e., when patients resumed athletic activity), tendon continuity had further improved, and average antero-posterior tendon diameter had increased to 13.8 mm. The entire tendon displayed uniformly low signal intensity. A brace is a straightforward method of treating Achilles tendon ruptures. Because of difficulties in image interpretation, it seems unlikely that CR will become widely used in the diagnosis and monitoring of tendon rupture. The results indicate that the use of MR imaging on an as-needed basis provides a superior understanding of tendon rupture healing. We conclude that further clinical application of MR imaging is warranted. (author)