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DVT after Achilles tendon rupture repair

  • 06

    Juan Almeida, Author and Contributor to Vein News and www.VeinsVeinsVeins.com

    Achilles tendon repair is an orthopediatic procedure that is associated with an increased risk for developing deep vein thrombosis (DVT).

    Makhdom et al. have published that symptomatic DVT incidence after Achilles tendon rupture repair was 23.47%.

    A likely reason for this is the need for immobilizatio of the foot to protect the repair, thus reducing calf muscle pumping effect of venous blood out of the leg.  As such, venous stasis contributes to the development of DVT.

    A recent study hypothesized that "early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery.

    The study was conducted by Susanna Aufwerber and colleagues from Sweden. 

    Study Method:  One-hundred and fifty patients with Achilles tendon rupture repair were randomized to treatment with early functional mobilization, encouraging full weightbearing and ankle motion in orthosis, or treatment-as-usual, i.e., 2 weeks of unloading in plaster cast followed by 4 weeks weightbearing in orthosis. Two and six weeks after surgery, patients were screened for DVT using standard US Doppler protocols.

    What were the results of this study?

    At 2 weeks, 28/96 (29%) of the patients in early functional mobilization group and 15/49 (31%) in the control group (n.s) had sustained a DVT.

    At 6 weeks, the DVT rate was 35/94 (37%) in the early functional mobilization and 14/49 (29%) in the control group/

    What are the conculsions of this study? 

    1) Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to standard care.

    2) The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing.

    They surmised that one can minimize the risk of DVT by encouraging patients to load at least 50% of body weight on the injured leg 1 week after surgery.

    Aufwerber S, Heijne A, Edman G, Silbernagel KG and Ackermann PW.  Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture:  a randomized controlled trial. Knee Surg Sports TraumatolArthrosc 2020; 28(1): 312-319.

    Makhdom MA, Cota A, Saran N and Chaytor R.  Incidence of Symptomatic deep vein thrombosis afer Achiles tendon rupture.  J Foot Ankle Surg 2013; 52: 584-587.