Abstract
Purpose and hypothesisAdjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.MethodsOne hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3–6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.ResultsAt 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.ConclusionsAdjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.Level of evidenceRandomized controlled trial, Level I.
Highlights
Patients with acute Achilles tendon rupture (ATR) are at high risk of immobilization-induced complications such as deep venous thrombosis (DVT) [8, 9] and a prolonged, impaired healing process with an unpredictable variation in final individual long-term outcome [16]
The intermittent pneumatic compression (IPC)-treated contralateral, intact AT demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002)
The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which prevents deep venous thrombosis
Summary
Patients with acute Achilles tendon rupture (ATR) are at high risk of immobilization-induced complications such as deep venous thrombosis (DVT) [8, 9] and a prolonged, impaired healing process with an unpredictable variation in final individual long-term outcome [16]. Leg immobilization causes reduced blood flow, [6] hampered metabolism and decreased production of collagen type I and III after ATR, which all result in an impaired healing process [4, 19]. Adjuvant intermittent pneumatic compression (IPC), which increases blood circulation during leg immobilization, was demonstrated to increase metabolism [10] and to reduce the risk of DVT after ATR [8, 9]. Whether adjuvant IPC treatment in ATR patients can counteract immobilization-induced impairments, by improving callus production has been unknown
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