Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

2019 ◽  
Vol 47 (13) ◽  
pp. 3229-3237 ◽  
Author(s):  
Melissa Hornbæk Pedersen ◽  
Liv Riisager Wahlsten ◽  
Henrik Grønborg ◽  
Gunnar Hilmar Gislason ◽  
Michael Mørk Petersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Nonoperative Treatment ◽  
Incidence Rates ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Sex

Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

Risk Factors for Failed Nonoperative Treatment and Rerupture in Acute Achilles Tendon Rupture

2018 ◽  
Vol 39 (6) ◽  
pp. 694-703 ◽  
Author(s):  
Aleksi Reito ◽  
Hanna-Liina Logren ◽  
Katri Ahonen ◽  
Heikki Nurmi ◽  
Juha Paloneva
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Patients

Background: Nonoperative treatment is feasible in most patients with acute Achilles tendon rupture. Risk factors associated with failed nonoperative treatment are poorly understood. We investigated risk factors associated with rerupture after nonoperative treatment and otherwise failed nonoperative treatment of Achilles tendon rupture. Methods: All patients diagnosed with acute Achilles tendon rupture between January 2009 and June 2016 and who underwent 8 weeks of nonoperative treatment with functional rehabilitation were included in the study. Patients with rerupture or otherwise failed nonoperative treatment were identified retrospectively. Time to rerupture and association of age, sex, time from injury, diabetes, and visits to the physiotherapist for cases of reruptures and otherwise failed nonoperative treatment were investigated. A total of 210 patients were included in the study. Results: Fifteen patients sustained a rerupture. Rerupture incidence was 7.1%. Incidence of late reruptures, those occurring after return to daily activities at 12 weeks, was 1.9%. Six patients had otherwise failed nonoperative treatment. Median time to rerupture was 23 days (6 to 61) after the end of the treatment. The incidence of all-cause failure was 10.0%. Male gender was associated with reruptures ( P = .013) and failed nonoperative treatment for any reason ( P = .029). Conclusion: It is important to highlight the increased risk of rerupture in male patients during the first month after the end of the nonoperative treatment. Age alone, even in male patients, was a poor indication for operative treatment since it did not predict early failure. Further studies will hopefully clarify the influence of activity level on the risk of rerupture. Level of Evidence: Level IV, retrospective case series.

scholarly journals Are Patients Presenting with an Achilles Tendon Rupture at Greater Risk of Rupturing Their Contralateral Tendon? A Retrospective Cohort Study with Minimum 2 Years Follow-up

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Joaquin Palma ◽  
Andres Villa ◽  
Alejandro Freundlich ◽  
Jose Dominguez Martinez ◽  
Felipe Fuentealba Secul ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Achilles Tendon ◽  
Median Time ◽  
Odds Ratio ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
High Risk Population ◽  
Injury Incidence

Category: Sports Introduction/Purpose: Study Design: Case-control Objective: To determine whether patients presenting with an Achilles tendon rupture are at greater risk of rupturing their contralateral tendon when compared to general population. Summary of Background Data: Extrinsic risk factors for Achilles tendon rupture, such as fluoroquinolones or local injections with corticosteroids, are well recognized. Genetic predisposition is another factor that has been proposed, since this pathology is more frequently seen in certain populations. Thus, it can be theorized that patients who have presented an Achilles tendon rupture are at higher risk of rupturing their contralateral tendon compared to general population. Previous reports by Arøen et al suggest than 10 out of 154 patients presented a contralateral injury (OR:176). Methods: Data from patients operated on from an acute Achilles tendon rupture were retrospectively retrieved from two academic centers. Patients were included if they had at least 2 years since their surgery and were willing to participate in the study. Each patient answered a telephone questionnaire regarding prior symptoms, contralateral rupture and risk factors (flouroquinolones, local corticosteroids and tobacco). Patients were excluded if they did not answer all questions or were unable to be contacted. Since data in our population is lacking, we used the overall incidence of Achilles tendon rupture published by Sheth et al. as the expected rate of Achilles tendon rupture in the general population. This value was compared to our cohort’s contralateral injury incidence to obtain an effect measure (odds ratio). Results: 246 consecutive Achilles tendon ruptures were treated during a 6-year follow-up period (2008-2016). 25 patients (8.5%) ruptured their contralateral tendon, equivalent to an incidence of 1407 ruptures per 100.000 inhabitants per year. Reported incidence of Achilles tendon rupture in the general population is 29 per 100.000 inhabitants per year. Odds ratio compared to the general population was 49.2 (95% CI: 34.1 – 73.7) (p <0.0001). Median time to contralateral rupture was 21.6 months (12 – 55) after the initial injury. There were no significant differences regarding age, sex, presence of external risk factors or prior symptoms in the group with a contralateral rupture. 81 patients (33%) experienced tendon pain of at least two weeks duration in relation to their initial rupture. Conclusion: Conclusion: Patients who sustain an Achilles tendon rupture are at higher risk (OR 49.2) of rupturing their contralateral tendon when compared to the general population. In our group, median time for the contralateral injury was 21.6 months. Discussion: Preventive strategies should be directed and conducted in this high risk population. Orthopedic surgeons should consider this information when counseling patients who sustained an Achilles tendon rupture.

Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture

2020 ◽  
Vol 41 (7) ◽  
pp. 784-792 ◽  
Author(s):  
Till D. Lerch ◽  
Andreas Schwinghammer ◽  
Florian Schmaranzer ◽  
Helen Anwander ◽  
Timo M. Ecker ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Return To Sport ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Sports Activity ◽  
Subjective Satisfaction ◽  
High Level

Background: There is controversy whether nonoperative or operative treatment for Achilles tendon rupture is superior. It is unknown if patients with acute Achilles tendon rupture return to previous sports activity. The purpose of this study was to assess 5-year return to sport and subjective satisfaction, minimum 1-year functional outcomes, and complications in patients following nonoperative treatment of Achilles tendon rupture with early weightbearing rehabilitation. Methods: An institutional review board–approved, retrospective observational study involving 89 patients was performed. Out of 114 consecutive patients, 89 (78%) responded to questionnaires for sports activity. Nonoperative treatment consisted of an equinus cast and rehabilitation boot that enabled early weightbearing. Sports activity at 1-year and 5-year follow-up was compared to the prerupture status. Based on the prerupture Tegner Activity Scale (TAS), patients were divided into low-level (<6) and high-level (≥6) activity groups. Clinical assessment at minimum 1-year follow-up was performed with the Thermann score. Mean clinical follow-up was 34 ± 23 months. Results: Overall, >70% of the patients returned to their previous sports activity level after a nonoperative early weightbearing treatment. Return-to-sport rate was significantly ( P = .029) higher for patients in the low-level activity group (91%) compared to patients (67%) in the high-level activity group at 5-year follow-up. Subjective satisfaction with treatment was good in both groups (93% and 96%, respectively). The mean Thermann score did not differ between the 2 groups at 1-year follow-up. There were 11 reruptures, 5 deep venous thromboses, and 1 case of complex regional pain syndrome. Conclusion: Nonoperative treatment for Achilles tendon rupture yielded good functional outcome and high patient satisfaction. For patients with a high preinjury activity level, return to previous sporting level (assessed by TAS) was possible in 67% of the patients compared to >90% of patients with low preinjury activity level. Level of Evidence: Level III, retrospective comparative series

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

Risk factors for achilles tendon rupture: A matched case control study

Injury ◽  
2017 ◽  
Vol 48 (10) ◽  
pp. 2342-2347 ◽  
Author(s):  
Peter C. Noback ◽  
Eugene S. Jang ◽  
Derly O. Cuellar ◽  
Mani Seetharaman ◽  
Emiliano Malagoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Case Control Study ◽  
Achilles Tendon Rupture ◽  
Case Control ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up

The Foot ◽  
2011 ◽  
Vol 21 (4) ◽  
pp. 204-206
Author(s):  
Aysegul Sarsilmaz ◽  
Makbule Varer ◽  
Gulten Coskun ◽  
Melda Apaydın ◽  
Orhan Oyar
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Mri Findings

scholarly journals Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

2019 ◽  
Vol 18 ◽  
pp. 232595821988493
Author(s):  
Sabina F. Mugusi ◽  
David Sando ◽  
Ferdinand M. Mugusi ◽  
Claudia Hawkins ◽  
Said Aboud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antiretroviral Therapy ◽  
Alanine Aminotransferase ◽  
Prospective Cohort ◽  
Combination Antiretroviral Therapy ◽  
Demographic Information ◽  
P Values ◽  
Increased Risk ◽  
Male Sex

Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL ( P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L ( P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.

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