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

Simon Svedman,Paul W Ackermann,Gunnar Edman

doi:10.1007/s00167-020-05945-2

Abstract

PurposeThe aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization.MethodsA cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation).ResultsThe total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71–79 vs 80–87; p < 0.01). Sixty-seven percent (95% CI 57–77%) of the patients devoid of DVT reported a good outcome (ATRS > 80) compared to 51% (95% CI 41–61%) of the patients sustaining a DVT (p < 0.05). Quality of life displayed significantly better outcome in the non-DVT versus DVT patients (mean = 75 (95% CI 71–79) vs. mean = 68 (95% CI 64–72); p < 0.05). A significant difference in total concentric work was observed between non-DVT and DVT patients (median = 1.9 kJ (IQR = 0.9 kJ) vs. median = 1.6 kJ (IQR = 1.0 kJ); p < 0.01).ConclusionSustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR.Level of evidenceIII.

Highlights

Immobilization of the lower limb is a considerable risk factor for venous thromboembolism, i.e., deep s(DVT) and pulmonary embolism (PE)
The most important finding of the present study was to demonstrate that suffering from a deep venous thrombosis (DVT) during the time of leg immobilization is associated with poorer subjective outcome in patients with an Achilles tendon rupture
Patients not afflicted by a DVT during leg immobilization exhibit significantly better patient-reported outcome of the validated Achilles tendon Total Rupture Score (ATRS) questionnaire, improved quality of life as assessed with the Foot- and Ankle Outcome Score (FAOS) questionnaire and exhibit a higher rate of good subjective outcome

Summary

Introduction

Immobilization of the lower limb is a considerable risk factor for venous thromboembolism, i.e., deep s(DVT) and pulmonary embolism (PE). The incidence of DVT during leg immobilization ranges between 4.3% and 40% in a wide. The efficacy and optimal thromboprophylaxis regimen during leg immobilization, especially in high-risk patients such as ATR, are largely unclear [1, 9, 11, 22, 39]. Current guidelines do not recommend general DVT prophylaxis during lower-limb immobilization, but rather suggest individual risk assessment [1, 11, 12]. Aside from the risk of DVTs to propagate and cause PE, impaired subjective outcome with symptoms such as limb swelling and pain may cause considerable long-term morbidity.

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