Longer duration of operative time enhances healing metabolites and improves patient outcome after Achilles tendon rupture surgery

Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. Results: The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to –0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time ( P ≤ .001) in both groups. Conclusion: EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. Registration: NCT02318472 (ClinicalTrials.gov identifier).

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Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2016-000114 ◽

2016 ◽

Vol 2 (1) ◽

pp. e000114 ◽

Cited By ~ 6

Author(s):

Md Abdul Alim ◽

Simon Svedman ◽

Gunnar Edman ◽

Paul W Ackermann

Keyword(s):

Patient Outcome ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture

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Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/0363546518793655 ◽

2018 ◽

Vol 46 (12) ◽

pp. 2929-2934 ◽

Cited By ~ 10

Author(s):

Simon Svedman ◽

Robin Juthberg ◽

Gunnar Edman ◽

Paul W. Ackermann

Keyword(s):

Patient Outcome ◽

Adverse Events ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Patient Reported Outcome ◽

Evidence Based ◽

Treatment Protocols ◽

Good Outcome ◽

Patient Reported

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).

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Pyruvate and lactate as local prognostic biomarkers of patient outcome after achilles tendon rupture

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13469 ◽

2019 ◽

Vol 29 (10) ◽

pp. 1529-1536 ◽

Cited By ~ 1

Author(s):

Francesco Addevico ◽

Simon Svedman ◽

Gunnar Edman ◽

Paul W. Ackermann

Keyword(s):

Patient Outcome ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Prognostic Biomarkers

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Analysis of Risk Factors for Deep Venous Thrombosis in Patients With Achilles Tendon Rupture: A Retrospective Study of 247 Patients

10.21203/rs.3.rs-404041/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Kai Liu ◽

Yanshi Liu ◽

Jiasharete Jielile ◽

Aihemaitijiang Yusufu

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Achilles Tendon ◽

Tendon Rupture ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Perioperative Period

Abstract Background and purpose The high incidence of deep venous thrombosis (DVT) was presented in patients with Achilles tendon rupture (ATR), and affects the prognosis of patients significantly. The purpose of this study was to identify and quantify the risk factors for perioperative DVT and the role of DVT in clinical outcomes, which may provide a guideline for DVT prevention and Achilles tendon repair. Methods The study was conducted on 247 patients who underwent surgical treatment for ATR at our institution from 2009 to 2019. Ultrasound results from injury to 4 weeks after operation were collected to diagnose DVT. Odds ratios (OR) were calculated using logistic regression to describe factors associated with DVT diagnosis including sex, age, body mass index (BMI), nicotine usage, mechanism of injury, rupture side, types of rupture, medical morbidity (hypertension, diabetes, coronary heart disease, stroke), time to operation, operative time and blood loss. The outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hind-Foot Scale Score at postoperative 3, 6, and 12 months. Results There were 216 males and 31 females with a mean age of 37.4 years (range from 20 to 75 years). Out of 247 patients, 113 patients were diagnosed with DVT during the perioperative period, accounting for 46 % of total patients. The independent risk factors were identified with age > 40 years (OR 0.41; 95% CI 0.21–0.82; p = 0.013), BMI > 26 (OR 0.39; 95% CI 0.19–0.79; p = 0.009), traumatic ATR (OR 2.44; 95% CI 1.22–4.91; p = 0.012), operative time (OR 0.95; 95% CI 0.91–1.01; p = 0.028), and blood loss (OR 1.09; 95% CI 1.03–1.14; p = 0.001). Worse patient-subjective and functional outcomes were presented in patients with a perioperative DVT according to ATRS and AOFAS. Conclusions Routine thromboprophylaxis should be encouraged in patients with ATR requiring surgery, which was caused by trauma. Age > 40 years and BMI > 26 were important risk factors for perioperative DVT. This study also showed that the presence of DVT of patients with ATR in the perioperative period has clear impairment of outcome within one year after surgery, which may postpone the return of athletes to the field severely.

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