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).

Background Neuromuscular electrical stimulation (NMES) may prevent muscle atrophy, accelerate rehabilitation and enhance blood circulation. Yet, one major drawback is that patient compliance is impeded by the discomfort experienced. It is well-known that the size and placement of electrodes affect the comfort and effect during high-intensity NMES. However, during low-intensity NMES the effects of electrode size/placement are mostly unknown. Therefore, the purpose of this study was to investigate how electrode size and pragmatic placement affect comfort and effect of low-intensity NMES in the thigh and gluteal muscles. Methods On 15 healthy participants, NMES-intensity (mA) was increased until visible muscle contraction, applied with three electrode sizes (2 × 2 cm, 5 × 5 cm, 5 × 9 cm), in three different configurations on quadriceps and hamstrings (short-transverse (ST), long-transverse (LT), longitudinal (L)) and two configurations on gluteus maximus (short-longitudinal (SL) and long-longitudinal (LL)). Current–density (mA/cm2) required for contraction was calculated for each electrode size. Comfort was assessed with a numerical rating scale (NRS, 0–10). Significance was set to p < 0.05 and values were expressed as median (inter-quartile range). Results On quadriceps the LT-placement exhibited significantly better comfort and lower current intensity than the ST- and L-placements. On hamstrings the L-placement resulted in the best comfort together with the lowest intensity. On gluteus maximus the LL-placement demonstrated better comfort and required less intensity than SL-placement. On all muscles, the 5 × 5 cm and 5 × 9 cm electrodes were significantly more comfortable and required less current–density for contraction than the 2 × 2 cm electrode. Conclusion During low-intensity NMES-treatment, an optimized electrode size and practical placement on each individual muscle of quadriceps, hamstrings and gluteals is crucial for comfort and intensity needed for muscle contraction.

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Background and method. Following Achilles tendon rupture (ATR)-surgery, patients using intermittent pneumatic compression (IPC) of the calf, compared to a plaster casted control-group (CTRL), exhibit reduced risk of deep venous thrombosis (DVT). Based on data from a randomized controlled trial (RCT), we investigated which dichotomized subgroups (based on age, sex, BMI and time to surgery (TTS)) within the IPC-(n= 66) and CTRL-group (n= 70) that were most likely to sustain a DVT, and which patients that had most benefit from postoperative IPC. Results. Age ≥39y (OR 6.06, p<0.001) and TTS >66h (OR 2.3, p=0.031) significantly increased the risk of DVT, but not sex or BMI. IPC-treatment significantly reduced the DVT-risk (OR 0.46, p=0.042), with more pronounced effect when considering age and TTS (OR 0.40, p=0.032). Although non-significant, females (OR 1.44, p=0.78) and patients with low BMI (OR 1.16, p=0.84) seemed to exhibit less DVT-preventive effect of IPC. Conclusion. Patients with age >38y and TTS>66h are at increased DVT-risk during post-operative leg immobilization, while adjuvant IPC shows good DVT-preventive effects among most patients, especially in those with high DVT-risk. Further trials are however warranted, to examine the low DVT-preventive effects of IPC discovered among females and patients with low BMI.