Case Report
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Kager's sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases

Year 2022, Volume: 39 Issue: 3, 907 - 909, 30.08.2022

Abstract

The Achilles tendon rupture is the most common tendon rupture in the lower extremity. Although magnetic resonance imaging (MRI) is accepted as the gold standard imaging approach for diagnosing the Achilles tendon rupture, radiography should be encouraged which is less expensive and more accessible and can simultaneously evaluate bone, air, and soft tissue. Kager’s triangle which is observed on lateral ankle radiography is important in evaluating the pathologies of Achilles tendon. We reported two cases of traumatic Achilles tendon rupture identified on radiographic imaging with a positive Kager's sign in emergency department and surgically confirmed. Both patients received early surgical repair and recovered completely. The clinical use of Kager's sign, which facilitates the radiological diagnosis of Achilles tendon rupture in the early period especially in emergency departments, should be increased and further studies should be conducted on its diagnostic value.

References

  • 1. Józsa L, Kvist M, Bálint BJ, et.al. The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med. 1989 May-Jun;17(3):338-43. doi: 10.1177/036354658901700305.
  • 2. Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle. 1985 Aug;6(1):34-8. doi: 10.1177/107110078500600107.
  • 3. Ufberg J, Harrigan RA, Cruz T, et.al. Orthopaedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med 2004;22: 596–600. doi: 10.1016/j.ajem.2004.09.007
  • 4. Belyea CM, Krul KP, Lause G, et.al. The Reliability of Kager's Triangle in Detecting Acute Achilles Tendon Ruptures. Orthopedics. 2020 Mar 1;43(2):e91-e94. doi: 10.3928/01477447-20191212-05. Epub 2019 Dec 16
  • 5. Kayser R, Mahlfeld K, Heyde CE. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Br J Sports Med. 2005 Nov;39(11):838-42; discussion 838-42. doi: 10.1136/bjsm.2005.018416.
  • 6. Aminlari A, Stone J, McKee R, et.al. Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis. J Emerg Med. 2021 Nov;61(5):558-567. doi: 10.1016/j.jemermed.2021.09.008. Epub 2021 Nov 17.
  • 7. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998 Mar-Apr;26(2):266-70. doi: 10.1177/03635465980260021801.
  • 8. Kerr J. Achilles tendon injury: assessment and management in the emergency department. Emerg Nurse. 2005 May;13(2):32-8. doi: 10.7748/en2005.05.13.2.32.c1186. 9. Mazzone MF, McCue T. Common conditions of the Achilles tendon. Am Fam Physician. 2002 May 1;65(9):1805-10. PMID: 12018803.
  • 10. Ly JQ, Bui-Mansfield LT. Anatomy of and abnormalities associated with Kager's fat Pad. AJR Am J Roentgenol. 2004 Jan;182(1):147-54. doi: 10.2214/ajr.182.1.1820147.
  • 11. Cetti R, Andersen I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Orthop Relat Res. 1993 Jan;(286):215-21. PMID: 8425349.
  • 12. Kokulu K, Akça HŞ. The Kager's Fat Pad Sign. J Emerg Med. 2017 Nov;53(5):760-761. doi: 10.1016/j.jemermed.2017.08.014. Epub 2017 Oct 4.
  • 13. Misir, A., Kizkapan, T.B., Arikan, Y. et al. Repair within the first 48 h in the treatment of acute Achilles tendon ruptures achieves the best biomechanical and histological outcomes. Knee Surg Sports Traumatol Arthrosc 28, 2788–2797 (2020). doi: 10.1007/s00167-019-05536-w.
Year 2022, Volume: 39 Issue: 3, 907 - 909, 30.08.2022

Abstract

References

  • 1. Józsa L, Kvist M, Bálint BJ, et.al. The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med. 1989 May-Jun;17(3):338-43. doi: 10.1177/036354658901700305.
  • 2. Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle. 1985 Aug;6(1):34-8. doi: 10.1177/107110078500600107.
  • 3. Ufberg J, Harrigan RA, Cruz T, et.al. Orthopaedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med 2004;22: 596–600. doi: 10.1016/j.ajem.2004.09.007
  • 4. Belyea CM, Krul KP, Lause G, et.al. The Reliability of Kager's Triangle in Detecting Acute Achilles Tendon Ruptures. Orthopedics. 2020 Mar 1;43(2):e91-e94. doi: 10.3928/01477447-20191212-05. Epub 2019 Dec 16
  • 5. Kayser R, Mahlfeld K, Heyde CE. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Br J Sports Med. 2005 Nov;39(11):838-42; discussion 838-42. doi: 10.1136/bjsm.2005.018416.
  • 6. Aminlari A, Stone J, McKee R, et.al. Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis. J Emerg Med. 2021 Nov;61(5):558-567. doi: 10.1016/j.jemermed.2021.09.008. Epub 2021 Nov 17.
  • 7. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998 Mar-Apr;26(2):266-70. doi: 10.1177/03635465980260021801.
  • 8. Kerr J. Achilles tendon injury: assessment and management in the emergency department. Emerg Nurse. 2005 May;13(2):32-8. doi: 10.7748/en2005.05.13.2.32.c1186. 9. Mazzone MF, McCue T. Common conditions of the Achilles tendon. Am Fam Physician. 2002 May 1;65(9):1805-10. PMID: 12018803.
  • 10. Ly JQ, Bui-Mansfield LT. Anatomy of and abnormalities associated with Kager's fat Pad. AJR Am J Roentgenol. 2004 Jan;182(1):147-54. doi: 10.2214/ajr.182.1.1820147.
  • 11. Cetti R, Andersen I. Roentgenographic diagnoses of ruptured Achilles tendons. Clin Orthop Relat Res. 1993 Jan;(286):215-21. PMID: 8425349.
  • 12. Kokulu K, Akça HŞ. The Kager's Fat Pad Sign. J Emerg Med. 2017 Nov;53(5):760-761. doi: 10.1016/j.jemermed.2017.08.014. Epub 2017 Oct 4.
  • 13. Misir, A., Kizkapan, T.B., Arikan, Y. et al. Repair within the first 48 h in the treatment of acute Achilles tendon ruptures achieves the best biomechanical and histological outcomes. Knee Surg Sports Traumatol Arthrosc 28, 2788–2797 (2020). doi: 10.1007/s00167-019-05536-w.
There are 12 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Case Report
Authors

Merve Osoydan Satıcı 0000-0002-3169-0724

Mehmet Muzaffer İslam 0000-0001-6928-2307

Gökhan Aksel 0000-0002-5580-3201

Serkan Emre Eroğlu 0000-0002-3183-3713

Early Pub Date August 30, 2022
Publication Date August 30, 2022
Submission Date April 22, 2022
Acceptance Date June 30, 2022
Published in Issue Year 2022 Volume: 39 Issue: 3

Cite

APA Osoydan Satıcı, M., İslam, M. M., Aksel, G., Eroğlu, S. E. (2022). Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases. Journal of Experimental and Clinical Medicine, 39(3), 907-909.
AMA Osoydan Satıcı M, İslam MM, Aksel G, Eroğlu SE. Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases. J. Exp. Clin. Med. August 2022;39(3):907-909.
Chicago Osoydan Satıcı, Merve, Mehmet Muzaffer İslam, Gökhan Aksel, and Serkan Emre Eroğlu. “Kager’s Sign; An Underestimated Radiographic Feature in Detecting Acute Achilles Tendon Rupture: A Report on Two Cases”. Journal of Experimental and Clinical Medicine 39, no. 3 (August 2022): 907-9.
EndNote Osoydan Satıcı M, İslam MM, Aksel G, Eroğlu SE (August 1, 2022) Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases. Journal of Experimental and Clinical Medicine 39 3 907–909.
IEEE M. Osoydan Satıcı, M. M. İslam, G. Aksel, and S. E. Eroğlu, “Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases”, J. Exp. Clin. Med., vol. 39, no. 3, pp. 907–909, 2022.
ISNAD Osoydan Satıcı, Merve et al. “Kager’s Sign; An Underestimated Radiographic Feature in Detecting Acute Achilles Tendon Rupture: A Report on Two Cases”. Journal of Experimental and Clinical Medicine 39/3 (August 2022), 907-909.
JAMA Osoydan Satıcı M, İslam MM, Aksel G, Eroğlu SE. Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases. J. Exp. Clin. Med. 2022;39:907–909.
MLA Osoydan Satıcı, Merve et al. “Kager’s Sign; An Underestimated Radiographic Feature in Detecting Acute Achilles Tendon Rupture: A Report on Two Cases”. Journal of Experimental and Clinical Medicine, vol. 39, no. 3, 2022, pp. 907-9.
Vancouver Osoydan Satıcı M, İslam MM, Aksel G, Eroğlu SE. Kager’s sign; an underestimated radiographic feature in detecting acute Achilles tendon rupture: A report on two cases. J. Exp. Clin. Med. 2022;39(3):907-9.