D Sasaki, M Hatori, S Kotajima, K Tanaka, S Kokubun
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
Corresponding author: Masahito Hatori, MD, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, Japan, 980-8574 Tel: 81-22-717-7242, Fax: 81-22-717-7248 Email: mhato@mail.tains.tohoku.ac.jp
SMJ 2005 50(4): 174-175
Abstract
Ossification of the Achilles tendon is a very unusual condition. We report a case with bilateral Achilles tendon ossification followed up for twelve years, treated twice surgically on the left side and conservatively on the right side. At the age of 51, the patient’s plain radiogram showed bilateral ossifications of the Achilles tendon (right 55 mm, left 15 mm in length). The left side small mass was removed. The right side mass was decided to be followed up because of its large size. At the age of 61, ossification recurred on the left side. Conservative treatment with etidronate disodium for two years failed to prevent ossification from progressing. At the age of 63, the mass on the right and left sides increased to 70 mm and 45 mm in length, respectively. The mass of the left side was excised again, and dull pain disappeared postoperatively on the left side.
Key words: Achilles tendon; ossification; long term follow-up; imaging; histology
Introduction
Ossification of the Achilles tendon is reportedly an unusual condition. In 1994, we reported a patient with bilateral Achilles tendon ossification treated surgically on the left side and conservatively on the right side.3 The aim of this paper is to report the long-term clinical course of this case after the primary surgery.
Case report
At the age of 51, he complained a dull pain in the bilateral Achilles tendon. Plain radiogram showed the ossification of 15 mm in length in the left Achilles tendon (Fig 1a) and 55 mm in the right Achilles tendon (Fig 2a). The left side mass was removed and dull pain disappeared. The right side ossification was followed up because of its large size.3 At the age of 61, the patient noticed a small mass and dullness in the left Achilles tendon. Plain radiography showed a 10mm sized ossification proximal to the previously removed site (Fig 1b). The right lesion size enlarged to 60mm. Conservative treatment with etidronate disodium (800 mg/day) was tried for two years, but ossification gradually increased to 45mm on the left (Fig 1c) and 70mm on the right (Fig 2b). The left side mass was excised again to lessen dull pain of the left Achilles tendon.
Discussion
Achilles tendon ossification was first described by Horing in 1908.5 The precise mechanism of Achilles tendon ossification has not been clarified. Lotke6 described that more than one-half of the reported patients had had surgery or trauma to the tendon. Fisher2 reported that calcification and ossification are probably a consequence of degenerative changes in collagen, the etiology of which may be related to vascular insufficiency. Achilles tendon ossification causes discomfort, restriction of motion, and disability of daily activities. Enlarged lesion is considered to have a risk of tendon rupture/fracture of the ossified lesion. If tendon rupture or fracture occurs, surgical treatment including suture of the ruptured tendon, excision of the ossified mass, or osteosynthesis of the fractured lesion is necessary.1,3,4 On the other hand, in the cases without any symptoms or with only discomfort or pain, the treatment of choice is still unclear. Some authors recommend that the ossified mass should be treated surgically because there is a risk of gradual enlargement; leading to difficulty in removing the elongated ossification, rupture of the tendon, and fracture of the ossification.3,4,6,7 But long-term results after the removal have not been described. In our case at the age of 51, excision was performed because the ossified mass was small and solitary on the left side. It was noteworthy that there was no formation of ossification at the same portion for twelve years after surgery. Recurred ossification caused discomfort, which was relieved by re-excision. Excision is thought to be indicated when symptomatic ossification is small and removable.
REFERENCES
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