PENDAHULUAN

1.1. LATAR BELAKANG

Tendon adalah jaringan fibrosa yang melekat otot ke tulang dalam tubuh manusia. Pasukan

diterapkan pada tendon mungkin lebih dari 5 kali berat badan Anda. . Dalam beberapa kasus

yang jarang terjadi, tendon dapat snap atau pecah . Kondisi yang membuat pecah lebih mungkin

termasuk suntikan steroid ke dalam tendon, penyakit tertentu (seperti gout atau

hiperparatiroidisme , dan memiliki golongan darah O).

Meskipun terbilang jarang, sebuah pecah tendon bisa menjadi masalah serius dan dapat

mengakibatkan mengerikan sakit dan cacat permanen jika tidak diobati. Setiap jenis pecah

tendon memiliki tanda-tanda dan gejala sendiri dan bisa diobati baik operasi atau medis

tergantung pada beratnya pecah dan kepercayaan dari ahli bedah .

1.2. RUMUSAN MASALAH

1. Definisi ruptur tendo? 2. Etiologi ruptur tendo? 3. Lokasi ruptur tendo? 4. Gejala klinis ruptur tendo? 5. Patofisiologi ruptur tendo? 6. Pemeriksaan diagnostic ruptur tendo? 7. Penatalaksanaan ruptur tendo?

BAB II

PEMBAHASAN

2.1. TENDON

2.1.1. Definisi tendon

Tendon adalah pita jaringan fibrosa yang fleksibel terletak di bagian belakang pergelangan kaki

yang menghubungkan otot betis dengan tulang tumit.. Tendon adalah struktur dalam tubuh yang

menghubungkan otot ke tulang. Otot rangka dalam tubuh bertanggung jawab untuk

menggerakkan tulang, sehingga memungkinkan untuk berjalan, melompat, angkat, dan bergerak

dalam banyak cara. Ketika otot kontraksi, hal itu menarik pada tulang menyebabkan gerakan ini.

Struktur yang memancarkan kekuatan kontraksi otot ke tulang disebut tendon.

2.1.2. Fungsi tendon

1. Membawa kekuatan tarik tendon dari otot ke tulang 2. membawa pasukan kompresi ketika membungkus tulang seperti katrol 3. Menekuk dan meregangkan (flex) semua sendi dan otot untuk menahan tulang. Tanpa

tendon, otot-otot hanya akan menjadi sekumpulan besar di satu bidang dan tidak akan

bisa bergerak.

4. Tendon yang menghubungkan otot dengan tulang. 5. Hal ini juga memungkinkan tendon untuk menyimpan dan memulihkan energi pada

efisiensi yang tinggi. Sebagai contoh, selama langkah manusia, Achilles tendon

peregangan sebagai dorsiflexes sendi pergelangan kaki. Pada bagian terakhir langkahnya,

sebagai kaki plantar-flexes (jari-jari kaki menunjuk ke bawah), yang disimpan energi

elastis dilepaskan. Lebih jauh, karena meregangkan tendon, otot dapat berfungsi dengan

kurang atau bahkan tidak ada perubahan panjang, yang memungkinkan otot untuk

menghasilkan kekuatan yang lebih besar.

6. Ketika otot gastrocnemius (di betis) kontraksi (lebih pendek), tendon yang melekat dari otot ke tulang tumit (kalkaneus) bergerak.

7. Sebagai memperpendek otot, tendon bergerak ketitik ke bawah kaki. Ini adalah tindakan yang memungkinkan seseorang untuk berdiri di ataskaki seseorang, berlari, melompat,

berjalan normal, dan untuk naik dan turun tangga.

2.2. DEFINISI RUPTUR TENDON

Ruptur tendon adalah Robek, pecah atau terputusnya tendon.

2.3. LOKASI RUPTUR TENDON

Empat daerah yang paling umum tempat terjadinya ruptur tendon

2.3.1. Qudriceps

Sebuah kelompok dari 4 otot, yang vastus lateralis, medialis vastus, intermedius vastus, dan

rektus femoris, datang bersama-sama tepat di atas Anda tempurung lutut ( patella ) untuk

membentuk tendon patella . Sering disebut quad, kelompok otot ini digunakan untuk

memperpanjang kaki di lutut dan bantuan dalam berjalan, berlari , dan melompat.

2.3.2. Achilles

Tendon Achilles berasal dari gabungan tiga otot yaitu gastrocnemius, soleus, dan otot plantaris.

Pada manusia, letaknya tepat di bagian pergelangan kaki. Tendon Achilles adalah tendon tertebal

dan terkuat pada tubuh manusia. Panjangnya sekitar 15 sentimeter, dimulai dari pertengahan

tungkai bawah. Kemudian strukturnya kian mengumpul dan melekat pada bagian tengah-

belakang tulang calcaneus. Tendon ini sangat penting untuk berjalan, berlari dan melompat

secara normal. Cidera karena olahraga dan karena trauma pada tendon Achilles adalah biasa dan

bisa menyebabkan kecacatan.

2.3.3. Rotator cuff

Rotator cuff terletak di bahu dan terdiri dari 4 otot: supraspinatus (yang umum tendon paling

pecah), infraspinatus, teres minor, dan m. subskapularis. Kelompok otot ini berfungsi untuk

mengangkat tangan ke samping, membantu memutar lengan, dan menjaga bahu keluar dari soket

tersebut.

2.3.4. Bisep

Otot bisep fungsi sebagai fleksor lengan dari siku. Otot ini membawa tangan ke arah bahu

dengan menekuk siku.

2.4. ETIOLOGI

1. Penyakit tertentu, seperti arthritis dan diabetes 2. Obat-obatan, seperti kortikosteroid dan beberapa antibiotik yang dapat meningkatkan

risiko pecah

3. Cedera dalam olah raga, seperti melompat dan berputar pada olah raga badminton, tenis, basket dan sepak bola

4. Trauma benda tajam atau tumpul pada bawah betis

2.5. GEJALA

1. Rasa sakit mendadak dan berat dapat dirasakan di bagian belakang pergelangan kaki atau betis

2. Terlihat bengkak dan kaku serta tampak memar dan kelemahan 3. Sebuah kesenjangan atau depresi dapat dilihat di tendon sekitar 2 cm di atas tulang tumit 4. Tumit tidak dapat digerakan turun atau naik

2.6. PATOFISIOLOGI

Kerusakan pada jaringan otot karena trauma langsung (impact) atau tidak langsung

(overloading). Cedera ini terjadi akibat otot tertarik pada arah yang salah,kontraksi otot yang

berlebihan atau ketika terjadi kontraksi ,otot belum siap,terjadi pada bagian groin muscles (otot

pada kunci paha),hamstring (otot paha bagian bawah),dan otot guadriceps. Fleksibilitas otot yang

baik bisa menghindarkan daerah sekitar cedera memar dan membengkak.

2.7. PEMERIKSAAN DIAGN

Anatomy

The Achilles tendon is the strongest and thickest tendon in the body, connecting the

gastrocnemius, soleus and plantaris to the calcaneus. It is approximately 15 centimeters

(5.9 inches) long and begins near the middle portion of the calf. Contraction of the gastrosoleus

plantar flexes the foot, enabling such activities as walking, jumping, and running. The Achilles

tendon receives its blood supply from its musculotendinous junction with the triceps surae and its

innervation from the sural nerve and to a lesser degree from the tibial nerve.

Caption

Causes

The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the

ankle, or by forced dorsiflexion of the ankle outside its normal range of motion.

Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon,

or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some

other common tears can occur from overuse while participating in intense sports. Twisting or

jerking motions can also contribute to injury.

Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of tendon

rupture, particularly achilles.

Risk factors

People who commonly fall victim to Achilles rupture or tear include recreational athletes, people

of old age, individuals with previous Achilles tendon tears or ruptures, previous tendon

injections or quinolone use, extreme changes in training intensity or activity level, and

participation in a new activity.

Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is

2940 years with a male-to-female ratio of nearly 20:1. Fluoroquinolone antibiotics, such as ciprofloxacin, and glucocorticoids have been linked with an increased risk of Achilles tendon

rupture. Direct steroid injections into the tendon have also been linked to rupture.

Quinolone has been associated with Achilles tendinitis and Achilles tendon ruptures for quite

some time now. Quinolones are antibacterial agents that act at the level of DNA by inhibiting

DNA Gyrase. DNA Gyrase is an enzyme used to unwind double stranded DNA which is

essential to DNA Replication. Quinolone is specialized in the fact that it can attack bacterial

DNA and prevent them from replicating by this process, and are frequently prescribed to elderly.

Approximately 2% to 6% of all elderly people over the age of 60 that have had Achilles ruptures

can be attributed to the use of quinolones.[1]

Diagnosis

Left Achilles tendon rupture

Achilles tendon rupture seen at sonography: discontinuity over several centimeters (red line). No

fracture or avulsion (radiograph).

Diagnosis is made by clinical history; typically people say it feels like being kicked or shot

behind the ankle. Upon examination a gap may be felt just above the heel unless swelling has

filled the gap and the Simmonds' test (aka Thompson test) will be positive; squeezing the calf

muscles of the affected side while the patient lies prone, face down, with his feet hanging loose

results in no movement (no passive plantarflexion) of the foot, while movement is expected with

an intact Achilles tendon and should be observable upon manipulation of the uninvolved calf.

Walking will usually be severely impaired, as the patient will be unable to step off the ground

using the injured leg. The patient will also be unable to stand up on the toes of that leg, and

pointing the foot downward (plantarflexion) will be impaired. Pain may be severe and swelling is

common.

An O'Brien test can also be performed which entails placing a sterile needle through the skin and

into the tendon. If the needle hub moves in the opposite direction of the tendon and the same

direction as the toes when the foot is moved up and down then the tendon is at least partially

intact.

Sometimes an ultrasound scan may be required to clarify or confirm the diagnosis. MRI can also

be used to confirm the diagnosis.

Imaging

Musculoskeletal ultrasonography can be used to determine the tendon thickness, character, and

presence of a tear. It works by sending extremely high frequencies of sound through your body.

Some of these sounds are reflected back off the spaces between interstitial fluid and soft tissue or

bone. These reflected images can be analyzed and computed into an image. These images are

captured in real time and can be very helpful in detecting movement of the tendon and

visualising possible injuries or tears. This device makes it very easy to spot structural damages to

soft tissues, and consistent method of detecting this type of injury. This imaging modality is

inexpensive, involves no ionizing radiation and, in the hands of skilled ultrasonographers, may

be very reliable.

Magnetic resonance imaging (MRI) can be used to discern incomplete ruptures from

degeneration of the Achilles tendon, and MRI can also distinguish between paratenonitis,

tendinosis, and bursitis. This technique uses a strong uniform magnetic field to align millions of

protons running through the body. these protons are then bombarded with radio waves that knock

some of them out of alignment. When these protons return they emit their own unique radio

waves that can be analysed by a computer in 3D to create sharp cross sectional image of the area

of interest. MRI can provide unparalleled contrast in soft tissue for an extremely high quality

photograph making it easy for technicians to spot tears and other injuries.

Radiography can also be used to indirectly identify achilles tears. Radiography uses X-rays to

analyse the point of injury. This is not very effective at identifying injuries to soft tissue. X-rays

are created when high energy electrons hit a metal source. X-ray images are acquired by utilising

the different attenuation characteristics of dense (e.g. calcium in bone) and less dense (e.g.

muscle) tissues when these rays pass through tissue and are captured on film. X-rays are

generally exposed to optimise visualisation of dense objects such as bone while soft tissue

remains relatively undifferentiated in the background. Radiography has little role in assessment

of Achilles' tendon injury and is more useful for ruling out other injuries such as calcaneal

fractures.[2]

Treatment

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches.

Among the medical profession opinions are divided what is to be preferred.

Non-surgical management traditionally was selected for minor ruptures, less active patients, and

those with medical conditions that prevent them from undergoing surgery. It traditionally

consisted of restriction in a plaster cast for six to eight weeks with the foot pointed downwards

(to oppose the ends of the ruptured tendon). But recent studies have produced superior results

with much more rapid rehabilitation in fixed or hinged boots.

Surgical repair of a ruptured Achilles tendon.

Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was

long thought to offer a significantly smaller risk of re-rupture compared to traditional non-

operative management (5% vs 15%).[3]

Of course, surgery imposes higher relative risks of

perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein

thrombosis, lingering anesthesia effects, etc.

However, four recent studies have scientifically tested the benefits of surgery, using randomized

streaming of patients into surgical and non-surgical protocols, and applying virtually identical

(and aggressive) rehabilitation protocols to both types of patients. All four such studies

completed to date have found only small, but statistically significant benefits from the surgery,

separated from the other confounding variables. They have all produced reasonably comparable

results in re-rupture rates (with each study adding a cautious note about small sample size, one

study showing 12% re-rupture in non-surgical treatment versus 4% re-rupture in surgical

treatment, which is statistically insignificant), strength, and range of motion, while most have

reaffirmed the greater complication rate from surgery.[4][5][6][7]

Two studies showed small, but

statistically significant differences in plantarflexion strength. The surgical group had

significantly better results in the heel-rise work, heel-rise height, concentric power, and hopping

tests at the 6-month evaluation than did the nonsurgical group. However, at the 12-month

evaluation, there was a significant between-groups difference only in the heel-rise work test.[8][9]

The relative benefits of surgical and nonsurgical treatments remains a subject of debate; authors

of studies are cautious about the preferred treatment.[10]

It should be noted that in centers that do

not have early range of motion rehabilitation available, surgical repair is preferred to decrease re-

rupture rates.[11]

Surgery

There are two different types of surgeries; open surgery and percutaneous surgery.

During an open surgery an incision is made in the back of the leg and the Achilles tendon is

stitched together. In a complete or serious rupture the tendon of plantaris or another vestigial

muscle is harvested and wrapped around the Achilles tendon, increasing the strength of the

repaired tendon.[12]

If the tissue quality is poor, e.g. the injury has been neglected, the surgeon

might use a reinforcement mesh (collagen, Artelon or other degradable material).

In percutaneous surgery, the surgeon makes several small incisions, rather than one large

incision, and sews the tendon back together through the incision(s). Surgery may be delayed for

about a week after the rupture to let the swelling go down.[13]

For sedentary patients and those

who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a better

treatment choice than open surgical repair.[14]