scholarly journals Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

2019 ◽  
Vol 28 (1) ◽  
pp. 312-319 ◽  
Author(s):  
Susanna Aufwerber ◽  
Annette Heijne ◽  
Gunnar Edman ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Control Group ◽  
Level Of Evidence ◽  
Treatment As Usual ◽  
Patient Reported

Abstract Purpose The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. Methods One-hundred and fifty patients with Achilles tendon rupture repair were randomized to treatment with early functional mobilization, encouraging full weightbearing and ankle motion in orthosis, or treatment-as-usual, i.e., 2 weeks of unloading in plaster cast followed by 4 weeks weightbearing in orthosis. At 2 and 6 weeks postoperatively, all patients were screened for DVT using compression duplex ultrasound. During the first 2 weeks postoperatively, patient-reported loading, pain and step counts were assessed. Results At 2 weeks, 28/96 (29%) of the patients in early functional mobilization group and 15/49 (31%) in the control group (n.s) had sustained a DVT. At 6 weeks, the DVT rate was 35/94 (37%) in the early functional mobilization and 14/49 (29%) in the control group (n.s). During the first postoperative week, the early functional mobilization group reported low loading and higher experience of pain vs. the control group (p = 0.001). Low patient-reported loading ≤ 50% (OR = 4.3; 95% CI 1.28–14.3) was found to be an independent risk factor for DVT, in addition to high BMI and higher age. Conclusions Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to treatment-as-usual. The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing. To minimize the risk of DVT, patients should be encouraged to load at least 50% of body weight on the injured leg 1 week after surgery. Level of evidence Therapeutic, level 1

scholarly journals Deep venous thrombosis after Achilles tendon rupture is associated with poor patient-reported outcome

2020 ◽  
Vol 28 (10) ◽  
pp. 3309-3317
Author(s):  
Simon Svedman ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Surgical Techniques ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Reported

Abstract Purpose The aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization. Methods A cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation). Results The total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71–79 vs 80–87; p < 0.01). Sixty-seven percent (95% CI 57–77%) of the patients devoid of DVT reported a good outcome (ATRS > 80) compared to 51% (95% CI 41–61%) of the patients sustaining a DVT (p < 0.05). Quality of life displayed significantly better outcome in the non-DVT versus DVT patients (mean = 75 (95% CI 71–79) vs. mean = 68 (95% CI 64–72); p < 0.05). A significant difference in total concentric work was observed between non-DVT and DVT patients (median = 1.9 kJ (IQR = 0.9 kJ) vs. median = 1.6 kJ (IQR = 1.0 kJ); p < 0.01). Conclusion Sustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR. Level of evidence III.

scholarly journals Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090652 ◽  
Author(s):  
Susanna Aufwerber ◽  
Annette Heijne ◽  
Gunnar Edman ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Achilles Tendon ◽  
General Health ◽  
Tendon Rupture ◽  
Standard Treatment ◽  
Negative Impact ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Control Group ◽  
Ankle Motion ◽  
Patient Reported

Background: Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impact of ankle immobilization after an ATR. Purpose: The primary aim of this study was to assess the efficacy of EFM compared with standard treatment (ie, 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis) regarding patient-reported and functional outcomes in patients with an ATR after acute operative repair. The secondary aim was to explore whether the occurrence of deep venous thrombosis (DVT) during the 2 postoperative treatments affected outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 135 patients who underwent ATR repair, randomized to either EFM, including immediate postoperative loading and ankle motion, or standard treatment, were evaluated with functional tests and 5 self-administered outcome questionnaires at 6 and 12 months postoperatively. Results: At 6 months, the EFM group scored higher on the RAND 36-Item Health Survey (RAND-36) questionnaire subscales of general health and vitality ( P < .05) compared with the control group. No significant differences between the groups were found on disease-specific questionnaires (Achilles tendon Total Rupture Score [ATRS] and Foot and Ankle Outcome Score [FAOS]). At 12 months, no significant differences on any of the patient-reported outcome measures or the functional heel-rise test were seen between the groups. The RAND-36 subscale of general health, however, exhibited higher values in the EFM group (82.6 ± 16.9) than the control group (77.1 ± 17.0) ( P = .051) at 12 months after the injury. Patients sustaining DVT postoperatively had lower self-reported outcomes on the ATRS, FAOS, and RAND-36 questionnaires at 6 and 12 months compared with patients not having sustained DVT (all P < .05). Conclusion: This study demonstrated that an accelerated postoperative protocol with immediate loading and ankle motion resulted in better general health and vitality at 6 months. However, there were no differences between the groups in the recovery of heel-rise function. Future studies should focus on the means to reduce the risk of DVT to improve patient outcomes after ATR. Registration: NCT02318472 (ClinicalTrials.gov identifier).

Incidence of Symptomatic Deep Venous Thrombosis after Achilles Tendon Rupture

2013 ◽  
Vol 52 (5) ◽  
pp. 584-587 ◽  
Author(s):  
Asim M. Makhdom ◽  
Adam Cota ◽  
Neil Saran ◽  
Ruth Chaytor
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture

High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study

2009 ◽  
Vol 17 (10) ◽  
pp. 1234-1238 ◽  
Author(s):  
Katarina Nilsson-Helander ◽  
Anders Thurin ◽  
Jon Karlsson ◽  
Bengt I. Eriksson
Keyword(s):  
Prospective Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
High Incidence ◽  
A Prospective Study

scholarly journals Individualized treatment for acute Achilles tendon rupture based on the Copenhagen Achilles Rupture Treatment Algorithm (CARTA): a study protocol for a multicenter randomized controlled trial

2020 ◽  
Author(s):  
Maria Swennergren Hansen ◽  
Marianne Toft Vestermark ◽  
Per Hölmich ◽  
Morten Tange Kristensen ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Randomized Controlled Trial ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Treatment Algorithm ◽  
Intervention Group ◽  
Individualized Treatment ◽  
Control Group ◽  
Randomized Controlled

Abstract Background: An individualized treatment algorithm (Copenhagen Achilles Rupture Treatment Algorithm - CARTA) based on the ultrasonographic appearance of an acute Achilles tendon rupture has been developed aiming to select the correct patients for operative and non-operative treatment. The objective of this study is to investigate if this individualized treatment algorithm gives a better functional outcome than treating all patients either operatively or non-operatively per default. Methods: This study is conducted as a multicenter three-armed randomized controlled trial. Participants are included from four hospitals in Denmark and randomized 1:1:1 to one of three parallel groups: 1) Intervention group: Participants are treated according to an individualized treatment algorithm, 2) Control group A: Participants are treated non-operative, 3) Control group B: Participants are treated operative. The individualized treatment algorithm for the intervention group is based on an ultrasonographic examination; tendon overlap and elongation below 7% is to be treated non-operative, while no tendon overlap and and/or elongation above 7% will be treated operative. 300 participants will be included over a period of 3 years. The primary outcome is the heel-rise work test at 12 months post-injury. Secondary outcomes are tendon elongation, the Achilles tendon Total Rupture Score (ATRS), the rate of re-ruptures and other complications. The primary analysis will be conducted as intention-to-treat analysis.Discussion: This trial will indicate if treatment of acute Achilles tendon rupture can be individualized based on the elongation and tendon overlap. It is hypothesized that different patients will benefit from different treatment instead of offering all the same treatment. Trial registration: ClinicalTrials.gov Identifier: NCT03525964. Registered 16 May 2018.

scholarly journals 3 Platelet rich plasma for acute achilles tendon rupture: a double-blind, multicentre, randomised, placebo-controlled trial

2019 ◽  
Vol 53 (13) ◽  
pp. 843.3-844
Author(s):  
DJ Keene ◽  
J Alsousou ◽  
P Harrison ◽  
P Hulley ◽  
S Wagland ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Goal Attainment ◽  
Tendon Rupture ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Soft Tissue Injuries ◽  
Double Blind ◽  
Patient Reported ◽  
Secondary Outcomes

AimSlow recovery and disability after Achilles tendon rupture are major challenges. Platelet Rich Plasma (PRP) is an autologous supraphysiological concentration of platelets from whole blood that has demonstrated positive cellular and physiological effects on healing in the laboratory and is widely used in musculoskeletal treatments. However, evidence from adequately powered, robust clinical trials is lacking. We aimed to determine the clinical efficacy of PRP for treatment of acute Achilles tendon rupture.Methods230 adults starting Achilles rupture non-surgical management within 12 days of injury were randomised to PRP injection or dry needle insertion to the rupture gap, under local anaesthetic. Participants were blinded to study treatment and received standardised rehabilitation. Blinded outcome assessments were at 4, 7, 13, and 24 weeks. The primary outcome was muscle-tendon function assessed by work performed during the heel-rise endurance test (HRET), measured with the Limb Symmetry Index (LSI) (0–100%; 100% denotes full recovery) at 24 weeks. Secondary outcomes were the Achilles Tendon Rupture Score (ATRS), quality of life (SF-12), pain and goal attainment. The trial was prospectively registered.ResultsOf 230 participants, 114 were allocated to PRP injection (103 received PRP), 116 were allocated to and received placebo. At 24 weeks, 201/230 (87%) completed the HRET and 214/230 (93%) completed patient reported outcomes. Participant characteristics between the groups were similar. There was no difference between groups at 24 weeks in LSI (mean difference = -4.373; 95% CI −11.217 to 2.471; p=0.195). There were no differences in the secondary outcomes and adverse event rates.ConclusionThis trial design and standardised PRP preparation secure the first robust clinical trial evidence for PRP in managing Achilles tendon rupture, and suggest that PRP offers no patient benefit. The use of PRP in soft tissue injuries must be questionable unless supported by equally robust evidence indicating positive outcomes.

High Plantar Force Loading After Achilles Tendon Rupture Repair With Early Functional Mobilization

2019 ◽  
Vol 47 (4) ◽  
pp. 894-900 ◽  
Author(s):  
Susanna Aufwerber ◽  
Annette Heijne ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Force Measurement ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Level Of Evidence ◽  
Force Loading ◽  
Fear Of Movement ◽  
Patient Reported ◽  
Plantar Force

Background: Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown. Purpose: The primary aim of this study was to assess the number of steps and the amount of loading in a weightbearing orthosis during the first 6 weeks after surgical ATR repair. A secondary purpose was to investigate if the amount of loading was correlated to fear of movement and/or experience of pain. Study Design: Case series; Level of evidence, 4. Methods: Thirty-four patients (mean ± SD age, 38.8 ± 8.7 years) with ATR repair were included. Early functional mobilization was allowed postoperatively in an orthosis with adjustable ankle range of motion. During the first postoperative 2 weeks, patient-reported loading and pain were assessed with a visual analog scale and step counts with a pedometer. At the 2- and 6-week follow-up, a mobile force sensor was used for measuring plantar force loading, and the Tampa Scale for Kinesiophobia was used to examine fear of movement. Results: Between the first and second weeks, there was a significant increase in the mean number of daily steps taken (from 2025 to 2753, P < .001) as well as an increase in self-reported loading (from 20% to 53%, P < .001). Patient self-reported loading was significantly associated with the plantar force measurement (rho = 0.719, P < .001). At 6 weeks, loading was 88.2% on the injured limb versus the uninjured limb. Fear of movement was not correlated with pedometer data, subjective loading, pain, or force data. Patients with less pain during activity, however, reported significantly higher subjective load and took more steps ( P < .05). Conclusion: This is the first study to demonstrate the actual loading patterns during postoperative functional mobilization among patients with surgically repaired ATR. The quick improvements in loading magnitude and frequency observed may reflect improved tendon loading essential for healing. Pain, rather than fear of movement, was associated with the high variability in loading parameters. The data of this study may be used to improve ATR rehabilitation protocols for future studies. Registration: NCT02318472 (ClinicalTrials.gov).

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

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.

scholarly journals The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial

2018 ◽  
Vol 46 (10) ◽  
pp. 2492-2502 ◽  
Author(s):  
Pernilla Eliasson ◽  
Anne-Sofie Agergaard ◽  
Christian Couppé ◽  
René Svensson ◽  
Rikke Hoeffner ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Home Exercise ◽  
Full Weightbearing ◽  
Tendon Elongation ◽  
Patient Reported ◽  
Functional Scores

Background: Treatment strategies for Achilles tendon rupture vary considerably, and clinical outcome may depend on the magnitude of tendon elongation after surgical repair. The aim of this project was to examine whether tendon elongation, mechanical properties, and functional outcomes during rehabilitation of surgically repaired acute Achilles tendon ruptures were influenced by different rehabilitation regimens during the early postsurgical period. Hypothesis: Restricted early weightbearing that permits only limited motion about the ankle in the early phase of tendon healing limits tendon elongation and improves functional outcome. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: 75 consecutive patients with an acute Achilles tendon rupture were included. They underwent surgical repair, and tantalum beads were placed in the distal and proximal parts of the tendon; thereafter, the patients were randomized into 3 groups. The first group was completely restricted from weightbearing until week 7. The second group was completely restricted from weightbearing until week 7 but performed ankle joint mobilization exercises. The first and second groups were allowed full weightbearing after week 8. The third group was allowed partial weightbearing from day 1 and full weightbearing from week 5. All patients received the same instructions in home exercise guidelines starting from week 9. Results: The rehabilitation regimen in the initial 8 weeks did not significantly influence any of the measured outcomes including tendon elongation. Achilles tendon elongation and tendon compliance continued for up to 6 months after surgery, and muscle strength, muscle endurance, and patient-reported functional scores did not reach normal values at 12 months. Conclusion: Differences in rehabilitation loading pattern in the initial 8 weeks after the repair of an Achilles tendon rupture did not measurably alter the outcome. The time to recover full function after an Achilles tendon rupture is at least 12 months. Registration: NCT02422004 ( ClinicalTrials.gov identifier).

scholarly journals A Prospective Study of Platelet-Rich Plasma as Biological Augmentation for Acute Achilles Tendon Rupture Repair

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Jian Zou ◽  
Xiaolian Mo ◽  
Zhongmin Shi ◽  
Tanzhu Li ◽  
Jianfeng Xue ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Control Group ◽  
Sf 36 ◽  
Study Results ◽  
A Prospective Study ◽  
Biological Augmentation

Acute Achilles tendon rupture is one of the most common tendon injuries in adults. We hypothesized that Platelet-Rich Plasma (PRP) can be used as biological augmentation for surgical treatment of acute Achilles tendon rupture. Our study is a prospective randomized controlled trial. Patients with acute Achilles tendon rupture undergoing surgical repair were randomly assigned into either control group or PRP group. End-to-end modified Krackow suture was performed in both groups. In the PRP group, PRP was injected into the paratenon sheath and around the ruptured tissue after the tendon was repaired. Postoperatively we evaluated isokinetic muscle strength at 3, 6, 12, and 24 months. In addition, ankle ROM, calf circumference, Leppilahti score, and the SF-36 score were evaluated at 6, 12, and 24 months after operation. At 3 months, the PRP group had better isokinetic muscle. The PRP group also achieved higher SF-36 and Leppilahti scores at 6 and 12 months. At 24 months, the PRP group had an improved ankle range of motion compared to the control group. Our study results suggest that PRP can serve as a biological augmentation to acute Achilles tendon rupture repair and improves both short and midterm functional outcomes.

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