scholarly journals 13 Deep vein thrombosis after acute achilles tendon rupture. An RCT comparing early controlled motion of the ankle with no motion

2019 ◽  
Author(s):  
Kristoffer Weisskirchner Barfod ◽  
Emil Nielsen ◽  
Beth Hærsted Olsen ◽  
Pablo Gustavo Vinicoff ◽  
Anders Troelsen ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Controlled Motion ◽  
Deep Vein

Achilles tendon rupture: what you need to know

2021 ◽  
pp. 1-7
Author(s):  
A Biggs ◽  
G Scott ◽  
MC Solan ◽  
M Williamson
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Best Practice ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Operative Management ◽  
Vein Thrombosis ◽  
History Of ◽  
Non Operative Management ◽  
Deep Vein

Heel pain and a history of a ‘pop’ or feeling ‘something go’ are the buzz phrases classically associated with Achilles tendon rupture. However, the diagnosis is often missed in clinical practice because of the assumption that this is a sporting injury suffered only by the young or middle-aged. In a sedentary older patient, the injury may be dismissed as an ankle sprain. If swelling is present but no injury is recalled then deep vein thrombosis is suspected, but Achilles rupture is not. The diagnosis of Achilles tendon rupture is clinical, based on history and examination. Radiological imaging (ultrasound scan) is useful to plan orthopaedic management and exclude concomitant deep vein thrombosis. In most cases, non-operative management with the ankle held plantar flexed in a boot is the current best practice.

A New Modification of Bosworth’s Technique to Repair Infectious Achilles Tendon Rupture

2019 ◽  
Author(s):  
Qipeng Wu ◽  
Yuan Xiong ◽  
Zhenhua Fang ◽  
Junwen Wang ◽  
Guohui Liu ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Skin Necrosis ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background The aim of this study was to assess radiographic and clinical outcomes of a new modified approach on the basis of Bosworth’s technique in the treatment of infectious Achilles tendon rupture (IATR). Materials and methods 15 patients (9 males and 6 females; 15 feet; average age of 38.3 years) were included in the study. After infection, the wounds were transferred to our department for treatment (Figure 1).Radiographic and clinical outcome in terms of the American Orthopaedic Foot&Ankle Society score (AOFAS), the Victorian institute of sports assessment Achilles (VISA-A), and the Achilles tendon total rupture score (ATRS) were investigated at 6 months, 12 months, and 24 months postoperatively. Results Preoperative AOFAS, VISA-A, and ATRS showed statistically significant improvement (p≤0.05) from35.03±6.81 (25-45), 21.04±8.17 (5-45), and 20.08±8.93 (6-55) to 90.04±5.32 (82-97), 95.11±3.09 (79-99), and 96.34±3.61 (89-97) at the last follow-up, respectively. All patients could lift heel on one foot and return to work at 12 to 16 weeks after operation (average 14.2 weeks). Overall, No complications such as infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon occurred at last follow-up. Conclusion The new modified approach of Bosworth’s technique provided powerful curative efficacy of infectious Achilles tendon rupture, without severe complications in terms of infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon. Level of Evidence: Level IV, case series.

scholarly journals Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture

2016 ◽  
Vol 98-B (12) ◽  
pp. 1635-1641 ◽  
Author(s):  
E. Domeij- Arverud ◽  
P. Anundsson ◽  
E. Hardell ◽  
G. Barreng ◽  
G. Edman ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Male Gender ◽  
Vein Thrombosis ◽  
Poor Outcome ◽  
Deep Vein

scholarly journals Risk of Deep Vein Thrombosis After Acute Achilles Tendon Rupture: A Secondary Analysis of a Randomized Controlled Trial Comparing Early Controlled Motion of the Ankle Versus Immobilization

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091590 ◽  
Author(s):  
Kristoffer Weisskirchner Barfod ◽  
Emil Graakjær Nielsen ◽  
Beth Hærsted Olsen ◽  
Pablo Gustavo Vinicoff ◽  
Anders Troelsen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Deep Vein ◽  
D Dimer

Background: Immobilization of the ankle joint has been suggested as a key element in the pathogenesis leading to deep vein thrombosis (DVT). Purpose: To investigate whether early controlled ankle motion (ECM) could reduce the incidence of DVT compared with immobilization (IM) in the treatment of acute Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 70 years were eligible for inclusion, and treatment was nonoperative. The ECM group performed movements of the ankle 5 times a day from weeks 3 to 8 after rupture. The control group was immobilized for 8 weeks. The outcome measure was DVT diagnosed with color Doppler ultrasound for above- and below-knee DVT at 2 and 8 weeks. The Achilles tendon Total Rupture Score, the heel-rise work test, and the Copenhagen Achilles ultrasonographic Length Measurement were performed at 4-, 6-, and 12-month follow-up. Results: A total of 189 patients were assessed for eligibility from February 2014 to December 2016. Of these, 130 were randomized: 68 patients were allocated to the ECM group and 62 to the IM group. All patients participated in follow-up at 8 weeks assessing for DVT. In total, 62 (47.7%) patients were diagnosed with DVT: 33 of 68 (48.5%) in the ECM group and 28 of 61 (46.8%) in the IM group ( P = .84). DVT did not affect treatment outcomes at 4, 6, and 12 months. D-dimer had low sensitivity (71%) for detecting DVT. Conclusion: We found that 1 in 2 patients presented with DVT in nonoperative treatment of acute Achilles tendon rupture. The ECM protocol revealed no benefit versus IM in reducing the incidence of DVT. DVT did not influence functional and patient-reported outcomes the first year after rupture. D-dimer seems an inappropriate test for detection of DVT in patients with acute Achilles tendon rupture. Registration: NCT02015364 ( ClinicalTrials.gov identifier).

scholarly journals Comparison of Two Surgical Methods in the Treatment of Acute Achilles Tendon Rupture: a Case-control Study

2021 ◽  
Author(s):  
Hao Yu ◽  
Fangyuan Wang ◽  
Jia Xie ◽  
Junfeng Zhan ◽  
Yunfeng Yao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Treatment Method ◽  
Suture Technique ◽  
Demographic Characteristics ◽  
Vein Thrombosis ◽  
Surgical Methods ◽  
Operative Recovery

Abstract Background: The Achilles tendon is the strongest tendon in the human body but also prone to injury and rupture, thereby requiring early diagnosis and treatment to prevent the development of lower limb dysfunction. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. As both traditional incision repair and minimally invasive repair have limitations, we propose a new surgical method: the modified Ma-Griffith method combined with minimally invasive small incision(M-G/MISI). This study aimed to compare the efficacy of M-G/MISI and the modified suture technique (MST) for the treatment of acute Achilles tendon rupture.Methods: We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. A total of 67 patients were included and divided into two groups: 34 males in the M-G/MISI treatment group and 33 patients (2 females and 31 males) in the MST group. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analysed using SPSS 24.0 for Windows (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0) to compare the treatment efficacy of the two surgical methods.Results: Although there was no difference in demographic characteristics between the two groups, there were significant differences in the incision length, intra-operative blood loss, post-operative Achilles tendon total rupture score, and post-operative American Orthopedic Foot and Ankle Society score. Post-operatively, there was one case of traumatic Achilles tendon rupture in the M-G/MISI group and one case each of infection and deep vein thrombosis in the modified suture group.Conclusion: After follow-up, the post-operative recovery of acute Achilles tendon rupture treated with M-G/MISI is better than that with the MST.

scholarly journals 12 Efficacy of early controlled motion of the ankle in non-operative treatment of acute achilles tendon rupture. An assessor-blinded RCT

2019 ◽  
Author(s):  
Kristoffer Weisskirchner Barfod ◽  
Maria Swennergren Hansen ◽  
Per Hölmich ◽  
Morten Tange Kristensen ◽  
Anders Troelsen
Keyword(s):  
Achilles Tendon ◽  
Operative Treatment ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Controlled Motion

scholarly journals Is Early Controlled Motion and Weightbearing Recommended for Nonoperatively Treated Acute Achilles Tendon Rupture? A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110246
Author(s):  
Yi-jun Zhang ◽  
Xiao Long ◽  
Jing-yu Du ◽  
Quan Wang ◽  
Xiang-jin Lin
Keyword(s):  
Systematic Review ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Meta Analysis ◽  
Achilles Tendon Rupture ◽  
Risk Of Bias ◽  
Return To Sports ◽  
Sports Activity ◽  
Number Of Patients ◽  
Controlled Motion

Background: There is disagreement as to whether early controlled motion and weightbearing confer a beneficial effect for nonoperatively treated acute Achilles tendon rupture (ATR) compared with immobilization and late weightbearing. Purpose: To conduct a meta-analysis of randomized controlled trials (RCTs) to determine whether early controlled motion and weightbearing results in different outcomes compared with immobilization and late weightbearing for nonoperatively treated patients with acute ATR. Study Design: Systematic review; Level of evidence, 1. Methods: We conducted a search in the PubMed, Web of Science, and EMBASE databases for relevant RCTs in humans from January 1981 to August 2020. The primary outcome was the Achilles Tendon Total Rupture Score (ATRS) at 1-year follow-up. The secondary outcomes were the rerupture rate, return to sports activity and work, and the heel-rise work (limb symmetry index [LSI]). Study quality was assessed using the Cochrane Collaboration risk of bias tool. Results: Included were 7 RCTs involving 424 participants (n = 215 treated with early controlled motion and weightbearing [early group], n = 209 treated with immobilization and late weightbearing [late group]). The quality assessment indicated a low risk of bias in all included RCTs. There was no difference between the early and late groups regarding the ATRS (mean difference [MD], -0.220; 95% CI, -4.489 to 4.049; P = .920). Likewise, we found no difference between the 2 groups in terms of the rerupture rate (odds ratio [OR], 1.107; 95% CI, 0.552 to 2.219; P = .775), the number of patients who returned to sports (OR, 0.766; 95% CI, 0.438 to 1.341; P = .351) and returned to work (OR, 0.706; 95% CI, 0.397 to 1.253; P = .234), the time to return to work (MD, -2.802 days; 95% CI, -6.525 to 0.921 days; P = .140), or the heel-rise work LSI (MD, -0.135; 95% CI, -6.243 to 5.973; P = .965). Conclusion: No significant differences were found between early controlled motion and weightbearing compared with immobilization and late weightbearing regarding the ATRS, the rerupture rate, return to sports activity and work, and the heel-rise work in nonoperatively treated patients with acute ATR.

scholarly journals Muscular Vein Thrombosis Prior to Immobilization in Tendo Achilles Rupture: A Previously Unrecognized Association

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Gaston Slullitel ◽  
Valeria Lopez ◽  
Juan Pablo Calvi ◽  
Gaitan Laura ◽  
Mark Mayerson
Keyword(s):  
Achilles Tendon ◽  
Doppler Ultrasound ◽  
Tendon Rupture ◽  
Color Doppler ◽  
Achilles Tendon Rupture ◽  
International Normalized Ratio ◽  
Venous System ◽  
Definitive Treatment ◽  
Vein Thrombosis ◽  
Posterior Tibial

Category: DTV prophylaxis Introduction/Purpose: Thromboembolic complications during lower-limb immobilization after Achilles tendon ruptures are common. Both operative and nonoperative treatments of Achilles tendon rupture include a period of immobilization which is a well-documented risk factor for distal vein thrombosis (DVT). The term DVT refers to the anterior/posterior tibial or the peroneal veins, and comprise the deep venous system. More recently, the role of muscular vein thrombosis (MVT) or isolated gastrocnemius or soleus vein thrombosis has been reported. However, there is no report of MVT associated with Achilles tendon rupture either before or after the initiation of treatment. We present a prospective series of patients treated for a rupture of the Achilles tendon and who were all evaluated with ultrasound for diagnosis of venous compromise prior to initiation of treatment. Methods: 21 patients who consecutively presented for treatment for an Achilles tendon rupture at the emergency department were included. All patients sustained the injurie while playing some kind of sport. 20 of 21 patients were male, and their average age was 48.8 years (range 34 to 62 years). Our prospective protocol included a routine ultrasound prior to the initiation of treatment to identify the location of the Achilles tendon rupture and simultaneously, a color Doppler ultrasound. Upon diagnosis, all patients were immobilized in an equinus cast while waiting for definitive treatment. Patients were treated either non operatively if a diagnosis of DVT was made, or with percutaneous surgical treatment in the absence of DVT. Upon DVT diagnosis patients were enrolled in a four week LWMH at curative doses therapy supervised by our team hematologist, in order to obtain an international normalized ratio (INR) of between 2 and 3. Results: Nine in the group of twenty one patients (42%) were diagnosed with a DVT in the Doppler ultrasound prior to the initial immobilization. In six of the nine patients diagnosed with a distal vein thrombosis thrombi was allocated in the muscular veins, two of the nine in the gastrocnemius veins and the remaining one in one of the posterior tibial vein. All of the patients had some kind of comorbidity, however only three of them had risk factors previously associated with the occurrence of distal vein thrombosis. In our evaluated cohort there were no cases of progression to pulmonary embolism (PE). Conclusion: To the authors knowledge this is the first publication that links the MVT diagnosis to the moment previous to the immobilization in Achilles tendon rupture. It is our perspective that although not well stablished there is at least a theoretical risk of further propagation to the profound venous system and subsequently to the pulmonary system, and this fact not only conditions the treatment of MVT itself, but also the treatment of the Achilles rupture. Clearly this is just a speculative concept and further evidence needs to be gathered in order to have a better understanding.

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