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

Svedman, Simon; Edman, Gunnar; Ackermann, Paul W.

doi:10.1007/s00167-020-05945-2

Cited by 9 publications

(10 citation statements)

References 38 publications

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“…PTS is a syndrome characterized by varying grades of pain, heaviness, swelling, and chronic ulceration of the leg 240 . DVT impairs long-term health-related quality of life and may negatively affect treatment results after ATRs 241,242 . The duration of immobilization in a below-the-knee cast and/or an orthosis/walking boot following an ATR is usually 6-8 weeks.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…DVTs after Achilles tendon rupture consists mainly of distal (below the knee) DVTs and are associated with a low risk of developing postthrombotic syndrome 338 . However, sustaining a DVT during leg immobilization significantly impairs patient-reported outcome 242 . The incidence of DVTs might be higher in patients older than 40 years, presumably because of a higher incidence of congestive heart failure, history of DVT or PE, and obesity 107,244 .…”

Section: Complicationsmentioning

confidence: 99%

“…Pharmacological prophylaxis has shown little or no effect on deep venous thrombosis (DVT) development during immobilization. The potentially negative impact on treatment results could be prevented by developing new methods of antithrombotic therapy194,242 . Intermittent pneumatic compression (IPC) as adjuvant therapy during cast and/or orthosis immobilization has shown promising results250 .…”

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confidence: 99%

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Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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Aufwerber and co-workers (2021) compared gait patterns between patients allowed to weight-bear immediately in an orthosis with patients deferring weight-bearing in a cast for two weeks followed by four weeks of weight-bearing in an orthosis. They found that immediate weight-bearing did not result in a more symmetrical gait pattern than deferring weight-bearing the first two weeks postoperatively 79 .

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Section: Treatment Optionsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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confidence: 99%

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Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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“…37 Our study demonstrated 10 incidences (8.50%) of DVT in the MIS group and 6 incidences (9.00%) of DVT in the open group (P > .99), which falls within the reported range in the literature from below 1% up to 50%. 2,3,27,29,30,33,37 Procedure duration was the only statistically significant difference found between the MIS and open groups, but only differed by 3.9 minutes on average, which may not factor in the decision to use either technique.…”

Section: Discussionmentioning

confidence: 88%

Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

Caolo

Eble

Rider

et al. 2021

Foot & Ankle Orthopaedics

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Background: There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. Methods: A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded. Results: PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). Conclusion: Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. Level of Evidence: Level III, retrospective cohort study.

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“…There is evidence that delay from injury to surgery and short duration of surgery are associated with inferior patient outcomes after ATR in addition to older age, obesity, and presence of deep venous thrombosis (DVT). 2,12,17,20 –22,26 Ideally, surgical training should not affect patient outcomes significantly. In orthopaedic surgery, however, there is some evidence that the level of surgeon experience may influence long-term outcomes.…”

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confidence: 99%

Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture

Saarensilta

Juthberg

Edman

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown. Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for analysis of adverse events. Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P = .028). In addition, the lateral difference (operated vs unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated on by resident surgeons ( P = .011 and 0.015, respectively). The number of adverse events did not differ significantly between the 2 groups. Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.

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

Cited by 9 publications

References 38 publications

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture

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