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Received：November 19, 2015, Revised：(1st) December 13, 2015, (2nd) December 14, 2015, Accepted：December 14, 2015

Corresponding to：Soo Uk Chae, Department of Orthopedic Surgery, Daeun Hospital, 277 Senae-ro, Wansan-gu, Jeonju 54969, Korea. E-mail：oschae68@hanmail.net

pISSN: 2093-940X, eISSN: 2233-4718Copyright ⓒ 2016 by The Korean College of Rheumatology. All rights reserved.This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Clinical ImageJournal of Rheumatic Diseases Vol. 23, No. 2, April, 2016http://dx.doi.org/10.4078/jrd.2016.23.2.136

Figure 1. Simple anteroposterior (A) and lateral (B) L-spine radiog-raphy show a bamboo spine.

Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

Seok Kyun Park, Soo Uk ChaeDepartment of Orthopedic Surgery, Daeun Hospital, Jeonju, Korea

A 43-year-old male patient had heel pain that was oc-curred spontaneously during walking 2 days before. At the time of visiting, bamboo spine was found in simple spine radiography, suggesting coexistence with ankylos-ing spondylitis (Figure 1). He was diagnosed with anky-losing spondylitis about 3 years ago at other hospital and treated with adalimumab (Humira; AbbVie Inc., North Chicago, IL, USA). The physical examination showed swelling, ecchymosis and dimpling in the posterior aspect of the ankle (Figure 2A). The initial radiograph of foot lat-

eral showed loss of Kager’s triangle (Figure 2B) and con-firmed by magnetic resonance imaging (Figure 2C). Ankylosing spondylitis is characterized by inflammation of the entheses and paravertebral structures, leading in time to bone formation at those sites [1,2]. Simple lateral foot image shows rupture of the Achilles tendon at calca-neal insertion site and combined with bony fragments. Acute Achilles tendon rupture can be managed by both

operative and nonoperative strategies. Operative acute Achilles tendon rupture treatment can effectively reduce

Achilles Tendon Rupture in Ankylosing Spondylitis

www.jrd.or.kr 137

Figure 3. (A) Intraoperative finding shows the rupture of the Achilles tendon at calcaneal insertion site and combined with bony fragments. (B) Achilles tendon rupture was treated with tendon to bone repair using suture anchors. (C) Postoperative finding showscomplete repair tendon to bone repair.

Figure 4. Six months follow-up simple lateral ankle image shows intact morphology of Kager’s tri-angle (arrow) (A), ultrasonography shows normal distal Achilles ten-don with fibrillar pattern at calca-neal insertion (arrowheads) (B). ACHI. T: Achilles tendon, LT: left,RT: right.

Figure 2. (A) The clinical photo shows swelling, ecchymosis and dimpling in the posterior aspect of the ankle. (B) Simple lateral ankle image shows loss of Kager’s triangle and bony fragments (arrow). (C) Sagittal T2 magnetic resonance image shows rupture of the Achilles tendon at calcaneal insertion siteand enthesopathic spur.

the risk of re-rupture but may also lead to more complica-tions related to open surgery. It is generally accepted that operation should be performed for athletes, young and fit patients and that conservative treatment may be suitable for the elderly. However, controversy remains with regard to optimal treatment for acute Achilles tendon rupture [3].An operation was performed because of insertional cal-

cific Achilles tendinosis is a painful and frequently dis-abling condition. The patient was placed in the prone po-sition under spinal anesthesia. Achilles tendon rupture was treated with tendon to bone repair using suture an-chors (Figure 3). As of the 6-month follow-up simple lat-eral ankle image shows intact morphology of Kager’s tri-angle (Figure 4A), ultrasonography shows normal distal Achilles tendon with fibrillar pattern at calcaneal in-sertion (Figure 4B). There was no visually altered gait or problem in daily activity and he had recovered to full activity. This case shows that we should be aware of the possibility of encountering an uncommon spontaneous Achilles tendon rupture in the calcaneal enthesopathies of a patient with ankylosing spondylitis.

Seok Kyun Park and Soo Uk Chae

138 J Rheum Dis Vol. 23, No. 2, April, 2016

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

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