Lee Conrad, Haarer Francesca, Titheradge Rachel, Iliopoulos Efthymios
Trauma and Orthopaedics Department, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.
Foot Ankle Orthop. 2023 Jun 11;8(2):24730114231178791. doi: 10.1177/24730114231178791. eCollection 2023 Apr.
Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol.
Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared.
A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance ( = .33).
In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction.
Level III, retrospective cohort study.
跟腱断裂可通过功能康复进行非手术治疗。然而，长期固定存在静脉血栓栓塞（VTE）的相关风险。早期负重可能会降低VTE风险，因此该措施被引入我们的康复方案中。我们调查了早期负重方案引入前后有症状VTE事件的发生率。
纳入2017年1月至2020年6月间经超声检查确诊为完全性跟腱断裂的成年人。在采用该方案前，患者被要求4周内不得负重。2018年，立即负重被引入治疗方案。两组队列中的所有患者均接受了4周的低分子量肝素治疗。对有症状VTE事件的患者进行了双功超声扫描或胸部计算机断层扫描检查。两名独立的匿名检查人员从电子记录中收集数据。比较有症状VTE的发生率。
共纳入296例患者。69例患者采用非负重方案治疗，227例患者采用早期负重方案治疗。每组各有2例患者发生深静脉血栓形成，早期负重组有1例发生肺栓塞。早期负重组的VTE发生率较低（1.3%对2.9%），但未达到统计学显著性（P = 0.33）。
在该队列研究中，我们发现非手术治疗跟腱断裂后有症状的VTE并不常见。我们并未证明早期负重和非负重康复方案在有症状VTE方面有降低作用。我们认为更大规模的研究可能有助于阐明早期负重是否有利于降低VTE。
三级，回顾性队列研究。
