Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2024 Aug;32(8):2184-2193. doi: 10.1002/ksa.12240. Epub 2024 May 26.
The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term.
This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS).
In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT.
DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age.
Level Ⅲ.
本研究旨在探讨深静脉血栓（DVT）对跟腱断裂（ATR）修复后 3 年患者结局的影响，以及术后 1 年至 3 年之间是否持续改善。次要目的是确定与长期患者结局受损相关的危险因素。
这项队列研究纳入了来自两项大型随机临床试验的 181 例接受 ATR 修复的患者，他们参加了 3 年随访评估。患者术后随机分为两种不同的负重干预组，与 2 周内使用膝下石膏固定相比。在固定期间，使用多普勒超声进行 DVT 筛查。术后 1 年和 3 年，通过经验证的跟腱抬高试验和自我报告问卷（跟腱总断裂评分，ATRS）评估功能和患者报告的结局。
总共，在 ATR 手术后 2 或 6 周的筛查中，181 例患者中有 76 例（42%）出现 DVT。与无 DVT 的患者相比，在固定期间发生 DVT 的患者在 3 年时的跟腱抬高总工作的肢体对称指数（LSI）更差，经年龄调整后（DVT 的平均 LSI 为 68%，无 DVT 的为 78%，p=0.027）。在 3 年时，在固定期间发生 DVT 的患者的 ATRS 较低（DVT 中位数为 88，无 DVT 为 93，p=0.046），但在调整年龄后无统计学意义。然而，与无 DVT 的患者相比，在 1 年至 3 年期间，患有 DVT 的患者的 ATRS、LSI 总工作和 LSI 最大高度均有所改善。
在固定期间发生 DVT 会影响 ATR 修复后 3 年患者的长期功能结局。临床医生应充分解决导致长期患者结局受损的危险因素，包括小腿肌肉萎缩、DVT 和年龄较大。
3 级。
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