382 Canine Sports Medicine and Rehabilitation
Treatment
Surgical correction is recommended for all
Achilles tendon avulsions and lacerations.
Primary repair of gastrocnemius tendon avul
sions is accomplished via bone tunnels through
the calcaneus and specialized suture patterns
with nonabsorbable suture. Additional support
can be provided with mesh grafts as well as
muscle and fascial flaps (Baltzer & Rist, 2009;
Morton et al.,2015; Katayama, 2016). The repair
can be augmented with platelet‐rich plasma,
which provides high concentrations of growth
factors that may increase vascular and fibro
blastic proliferation (Hernández‐Martínez et al.,
2012)
Postoperative immobilization of the joint
is essential for several weeks to relive stress
on the tendon and allow adequate healing.
Immobilization is performed with the tarsus
in an extended position using a cast, splint,
external skeletal fixation, or transcalcaneal
screw (Nielsen & Pluhar, 2006; Braden, 1974).
Alternatively, a hinged tarsal orthotic device
can be custom molded following surgery (see
Chapter 11) (Figure 14.36). In theory, this allows
for a gradual increase in the range of motion of
the tarsus following surgical repair. However,
our ability to alleviate strain on the Achilles
tendon while immobilized is not as one may
theorize, in fact, one study failed to demonstrate
a difference in maximum strain after immobili
zation, compared with maximum strain during
normal motion in an experimental design
(Lister et al., 2009).
Function following surgical repair is generally
very good, despite the lack of normal tendon
architecture (Kramer et al., 2001).
Tendon injuries with core lesions or incom
plete tears can be treated with conservative
management. This may include physical reha
bilitation and immobilization, as well as the use
of orthobiologics (Chen et al., 2012). Ultrasound
has been shown to increase tendon healing viaFigure 14.34 This patient with chronic gastrocnemius
avulsion presents with a weight‐bearing plantigrade
stance and digital flexion due to increased stress on the
intact superficial digital flexor tendon.
Figure 14.35 Achilles tendon avulsion. Radiography
may demonstrate soft tissue swelling at the level of the
injury with possible avulsion of bone fragments and/or
mineralization of the tendon.