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

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.

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Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-011-2166-6 ◽

2011 ◽

Vol 470 (1) ◽

pp. 270-274 ◽

Cited By ~ 47

Author(s):

Arush Patel ◽

Brent Ogawa ◽

Timothy Charlton ◽

David Thordarson

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Vein Thrombosis ◽

Deep Vein

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Acute presentation of deep vein thrombosis in Achilles tendon rupture: A case report

International Journal of Case Reports and Images ◽

10.5348/ijcri-2013-02-270-cr-4 ◽

2013 ◽

Vol 4 (2) ◽

pp. 99

Author(s):

Rafik Yassa ◽

Kiran Singh Kandola ◽

A Sharma

Keyword(s):

Deep Vein Thrombosis ◽

Case Report ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Vein Thrombosis ◽

Acute Presentation ◽

Deep Vein

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

10.21203/rs.2.18598/v1 ◽

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.

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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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120915909 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091590 ◽

Cited By ~ 3

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).

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

10.21203/rs.3.rs-149540/v1 ◽

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00395 ◽

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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The Prevalence of Concomitant Deep Vein Thrombosis, Symptomatic or Asymptomatic, Proximal or Distal, in Patients With Symptomatic Pulmonary Embolism

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618779143 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1352-1357 ◽

Cited By ~ 6

Author(s):

Jana Hirmerova ◽

Jitka Seidlerova ◽

Zdenek Chudacek

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Male Gender ◽

Routine Testing ◽

Factors Associated ◽

Vein Thrombosis ◽

Symptomatic Pulmonary Embolism ◽

Compression Ultrasound ◽

Sensitivity Specificity ◽

Deep Vein

Patients with pulmonary embolism (PE) may have symptomatic or asymptomatic concomitant deep vein thrombosis (DVT). The reported prevalence of PE-associated DVT is variable, and thus, the utility of routine testing is controversial. The aim of our study was to analyze the prevalence of DVT and the factors associated with proximal DVT/whole-leg DVT in patients with symptomatic PE. In 428 consecutive patients (mean age: 59 ± 16.4 years; 52.3% men), we performed clinical examination and complete bilateral compression ultrasound and ascertained medical history and risk factors for DVT/PE. χ2 and t tests were used. Deep vein thrombosis was found in 70.6%; proximal DVT in 49.5%. Sensitivity/specificity of DVT symptoms was 42.7%/93.7% for whole-leg DVT and 47.6%/83.3% for proximal DVT. Male gender significantly prevailed among those with whole-leg DVT and with proximal DVT (58.9% and 61.8%). Active malignancy was significantly more frequent in the patients with proximal DVT than without proximal DVT (10.4% vs 3.7%). In conclusion, the prevalence of PE-associated DVT is quite high but clinical diagnosis is unreliable. In our group, male gender and active malignancy were significantly associated with the presence of concomitant proximal DVT.

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