A 35-year-old male recreational runner presents with acute onset heel pain while sprinting. He felt a 'pop' and has difficulty pushing off. Thompson's test is positive. MRI is performed. Which MRI sequence best demonstrates the Achilles tendon rupture, and what is the primary treatment in young active patients?
- A T1-weighted sequence; primary surgical repair
- B Proton density fat-suppressed or STIR sequence; primary surgical repair ✓
- C Gradient echo sequence; functional brace with equinus positioning
- D DWI sequence; immediate cast immobilization
Explanation
Proton density fat-suppressed or STIR (Short TI Inversion Recovery) sequences are best for demonstrating tendon tears, showing bright signal within the tendon at the rupture site with surrounding edema. For young active patients and athletes, surgical repair (end-to-end tenorrhaphy) provides superior re-rupture rates (~3-4%) compared to functional bracing (~8-12%) and better return to high-demand activities, though both methods are now considered acceptable in shared decision-making. Thompson's test (calf squeeze test): positive when no plantar flexion occurs on squeezing the calf.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.