Left Achilles Tendon Rupture in a Male Collegiate Soccer Player Welch B, ATS*; Leick C, MAT, ATC*; Wilkins S, MS, ATC*: *University of Nebraska at Omaha, Omaha, NE. Context Differential Diagnosis Uniqueness The Achilles tendon (AT) is the thickest and strongest tendon within the entire human body.1 There has been a recent increase in the number of AT ruptures within the athletic population. Approximately 22 out of 100,000 athletes will rupture their AT.2 AT injuries are among the most common within all of sports including Achilles tendinitis, tenosynovitis, fasciitis, and full ruptures.3 NCAA Division I soccer forward (21-year old male, height=180 cm, mass=73 kg). Had been dealing with AT pain for previous two years. November 14, 2017, patient went down on the field following a match victory. Patient reported loud popping sound while attempting a backflip. Attempted to get up and walk but could not. AT began evaluation with ankle and found laxity in ATFL but nothing else. Got into ATR and got sock off to realize the AT was no longer visibly attached. Positive Thompson Test for AT rupture. References 1.Maquirriain J. Achilles tendon rupture: Avoiding tendon lengthening during surgical repair and rehabilitation. Yale J Biol Med. 2011; 84(3): 289-300. 2.Jandacka D, Silvernail JF, Uchytil J, Zahradnik D, Farana R, Hamill J. Do athletes alter their running mechanics after an Achilles tendon rupture? J Foot Ankle Res. 2017; 10(53): 1-8. doi:10:1186/s13047-017-0235-0 3.Reiman M, Burgi C, Strube E, et al. The utility of clinical measures for the diagnosis of Achilles tendon injuries: A systematic review with meta-analysis. J Athl Train. 2014; 49(6): 820-829. doi:10.4085/1062-6050-49.3.36 4. Froberg A, Cissa AS, Larsson M, et al. Altered patterns of displacement within the Achilles tendon following surgical repair. Knee Surg Sports Traumatol Arthrosc. 2017; 25(6): 1857-1865. doi:10.1007/s00167-016-4394-5 Gastrocnemius/soleus strain ATFL sprain Fibular fracture Calcaneal fracture Shepard’s fracture Ice, intermittent compression, and IFC and Hi-Volt electrical stimulation for pain relief and edema reduction. Open Surgical technique done to tie up both ends of tendon. 1-2 weeks of similar treatment from before surgery along with walking boot, heel lift, and crutches. 2 weeks, ankle ROM and hip strengthening began. Rehab progressed from ROM exercises into stretching, strengthening, balance, unidirectional agility, side-to-side agility, and sport specific activity. Injury occurred after months of chronic AT pain. Immediate partial weight bearing with walking boot right after surgery, with crutches assistance. Excessive tendon thickness throughout the entirety of rehabilitation thus far. Anterior ankle tightness has been a chronic issue. Thompson Test for AT rupture appears to be highly effective for AT rupture diagnosing. Surgical repair was a safe and successful route for return to activity. Critical to not rush through rehabilitation. Addressinging AT tendinopathies before they continue to worsen is the best way to avoid AT rupture. Future rupture possibility is increased in risk as the fascia and muscle belly could present with adhesions.4 Treatment Conclusion Background Signs and Symptoms Anterior Posterior Figure 2. Keloids developed over the AT Figure 3. Opsen surgical technique used by the orthopedic doctor Figure 1. Achilles Tendons the day of the injury Medial Lateral university of Nebraska at Omaha