MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures

Clinical Diagnostic Criteria
David N. Garras MD, Steven M. Raikin MD,
Suneel B. Bhat MD, MPhil, Nicholas Taweel DPM, PT,
Homyar Karanjia DPM
Received: 24 August 2011 / Accepted: 2 April 2012 / Published online: 27 April 2012
The Association of Bone and Joint Surgeons1 2012
Abstract
Background Achilles tendon ruptures are common in
middle-aged athletes. Diagnosis is based on clinical examination
or imaging. Although MRI is commonly used to
document ruptures, there is no literature supporting its routine
use and we wondered whether it was necessary.
Questions/purposes We (1) determined the sensitivity of
physical examination in diagnosing acute Achilles ruptures,
(2) compared the sensitivity of physical examination with
that of MRI, and (3) assessed care delays and impact
attributable to MRI.
Methods We retrospectively compared 66 patients with
surgically confirmed acute Achilles ruptures and preoperative
MRI with a control group of 66 patients without preoperative
MRI. Clinical diagnostic criteriawere an abnormalThompson
test, decreased resting tension, and palpable defect. Time to
diagnosis and surgical procedures were compared with those
of the control group.
Results All patients had all three clinical findings preoperatively
and complete ruptures intraoperatively (sensitivity
of 100%). MR images were read as complete tears in 60,
partial in four, and inconclusive in two patients. It took a
mean of 5.1 days to obtain MRI after the injury, 8.8 days for
initial evaluation, and 12.4 days for surgical intervention. In
the control group, initial evaluation occurred at 2.5 days
and surgical intervention at 5.6 days after injury. Nineteen
patients in the MRI group had additional procedures whereas
none of the control group patients had additional procedures.
Conclusions Physical examination findings were more
sensitive than MRI. MRI is time consuming, expensive,
and can lead to treatment delays. Clinicians should rely on
the history and physical examination for accurate diagnosis
and reserve MRI for ambiguous presentations and subacute
or chronic injuries for preoperative planning.
Level of Evidence Level II, diagnostic study. See the
Guidelines for Authors for a complete description of levels
of evidence.