SURGICAL REPAIR OF ACHILLES TENDON RUPTURE IN A DOG

N. Nagaraju1, B.R. Balappanavar1 and L. Ranganath2
1Assistant Professor, Department of Veterinary Surgery & Radiology,2Dean, Veterinary College,
KVAFSU, Hassan (Karnataka). [Received: 25.5.2018; Accepted: 26.11.2018]
{DOI 10.29005/IJCP.2018.10.2.183-185}

Achilles tendon rupture in dogs is a common traumatic lesion. One and half year old Doberman male dog was
presented with complete rupture of achilles tendon in left hind leg. The gap between the two cut ends of tendon was 2 cm with full extension of the tarsal joint. Ruptured tendon were sutured by Bunnel Mayer technique, with
immobilisation of the limb using Thomas splint. Dog had uneventful recovery.
Keywords: Achilles tendon, Complete rupture, Dog, Dropped hock.

The achilles tendon is the strongest tendon in the structure of the musculoskeletal system in the dog. In dogs the tendo calcaneus communis originates from different muscle-tendon units that conjoin at the heel.
its main function is in rear limb forward progression and it contributes to passive support of the hock (Fahie, 2005). The aetiology of achilles tendon injuries in dogs is usually traumatic. The nature of the trauma influences the type of tendon of tendon ends (Clark, 2001). Weakening or rupture of the tendon structure also can occur secondarily to
systemic diseases like Cushing’s disease or iatrogenic aetiologies (Montogomery and Fitch, 2003). Based on anatomical location and severity of lesions of the achilles tendon breakage has been classified into 3 types:
type 1 is complete rupture, type 2 has three subtypes for partial rupture with a lengethened achilles injury and may result in acute rupture of the tendon with partial or complete loss of integrity of the structure sometimes with exposure tendon system and type 3 is a tendinosis or peritendinosis (Meustege, 1993; Fahie, 2005). The clinical signs associated with the rupture of the achilles tendon will vary depending on the severity of the injury but plantigrade position or dropped hock and the swelling around the tendon insertion on the hock are the main symptoms observed in a dog with complete rupture of the tendon.

Case History and Observations A one and half year old Doberman male dog with a history of accidental trauma
by knife at the hock joint with left hind leg lameness was presented to Veterinary College Hospital, Hassan.. Upon examination, septic wound at left hock region with serosanguinous discharge was noticed with dropped hock condition (Fig. 1).Radiographic examination revealed rupture of tendoachilles with air pockets suggesting infection (Fig. 2). The hematobiochemical parameters were within the normal range. It was decided to correct the tendon rupture by tenorraphy.

Surgical Management
The dog was anesthetized and positioned in right lateral recumbency. Surgical debridement of the wound was
performed. Cut ends of the tendon were isolated from the surrounding tissue, debrided, irrigated with normal saline and apposed with Bunnel Mayer suture technique using braided silk no 1 (Fig. 3). Bursa covering tendon was sutured using polyglactin 910 no. 1. Skin was closed with a no-tension interrupted sutures using polyamide suture material no. 1-0. A bandage (in physiological position) with a craniocaudal splint was applied and maintained for 10 weeks, both to protect the limb from infection and to support and immobilize the tibiotarsal joint. The limb was
immobilized with Thomas splint using 4mm

aluminium rod. After 10 weeks, the dog was re-evaluated and was found able to bear partial weight. On palpation, the sutured portion of tendon appeared swollen, irregular and firm. The Thomas splint was continued
for another month. The owner was informed to restrict the dog’s activity and to perform passive physiotherapy intermittently by slow extention and flexion of the joint to prevent tendon adhesion and muscular atrophy.
Postoperatively the dog was given meloxicam, (0.2 mg/kg, bid, p.o.) for the first 5 days and cephalexin ( 25 mg/kg, bid, p.o.) for 10 days consecutively.

Results and Discussion
An uneventful recovery with complete bearing of weight was observed by three months period (Fig. 4). Out comes are typically quite good although some patients may never regain full strength as mentioned earlier. The suture pattern should not adversely affect the tendon vasculature and should avoid adhesion formations as also
recommended by Moores et al. (2004). Bunnel Mayer technique using sterlized braided silk no1 provided sufficient stability in the anastamosis. Spinell et al. (2010) have indicated that steel wires, polidioxanone or polyglyconate may also be used in such cases. Prevention of automutilation and immobilization of the limb using Thomas
splint hastened the wound healing. The physiotherapy provided in the post operative period prevented the tendon adhesion and muscular atrophy as also recommended by Shani and Shahar, (2000) and Montgomery and Fitch (2003).

References
Clark, D.M. (2001). Tendon lesion and its treatment. In: Bojrab M.J. (Eds.). Disease Mechanisms in Small Animal; 3rd edn., Giraldi, Bologna, Lea & Febiger, Philadelphia, U.S.A. Pp. 1414–1418.

Fahie, M.A. (2005). Healing, diagnosis, repair, and rehabilitation of tendon conditions. Vet. Clin. Small Ani. Pract.,
35: 1195–1211.

Meutstge, F.J. (1993). The classification of canine Achille’s tendon lesions. Vet. Comp. Orthop. Traumatology, 6: 53–55.

Montgomery, R. and Fitch, R. ( 2003). Muscle and tendon disorders. In: Slatter, D. (Eds.). Text Book of Small Animal Surgery, 3rd edn., W.B. Saunders, Philadelphia, U.S.A. Pp. 2264-2272.

Moores, A.P., Owen, M.R. and Tarlton, J.F. (2004). The three loop pulley suture versus two locking loop sutures for the repair of canine Achilles tendon. Vet. Surg., 33: 131-137.

Nielsen, C, and Pluhar, G.E. (2006). Outcome following surgical repair of Achilles tendon rupture and comparison
between post-operative tibiotarsal immobilization methods in dogs. Vet. Comp. Orthop. Traumatology, 19: 246–
249.

Shani, J. and Shahar, R. (2000). Repair of chronic complete traumatic rupture of the common calcaneal tendon in a dog, using a fascia lata graft. Case report and literature review. Vet. Comp. Orthop. Traumatology, 13: 104-108.

Spinella, G.R. Tamburro, G., Loprete, J.M., Vilar and Valentini, S. (2010). Surgical repair of Achilles tendon rupture in dogs: a review of literature, a case report and new perspectives. Vet. Medi., 55: 303- 310.

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