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Deep Venous Thrombosis and Tendon Healing

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Metabolic Influences on Risk for Tendon Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 920))

Abstract

Tendon metabolism after acute Achilles tendon rupture (ATR) is associated with major complications related to immobilization, which results in reduced circulation, high risk of deep venous thrombosis (DVT), impaired healing and functional deficits.

DVT has been demonstrated to occur in up to 50 % of the patients with ATR. Suffering from a DVT during tendon healing has been demonstrated as an independent predictive factor for impaired patient outcome at 1 year after ATR, suggesting that specific interventions are warranted to prevent DVT. Since pharmacological DVT prophylaxis has low or no effect during lower leg immobilization it is speculated whether adjuvant treatment with intermittent pneumatic compression (IPC) applied during lower limb immobilization can reduce the incidence of DVT.

IPC, which acts through mechanical, chemical and molecular mechanisms, has been demonstrated to enhance neuro-vascular ingrowth in a tendon repair model and stimulate collagen production leading to improved maximum force during healing.

Recently, a prospective randomized trial compared adjuvant IPC applied under an orthosis versus plaster cast only in ATR patients. The study found at 2 weeks post-operatively 21 % DVTs in the IPC-group compared to 37 % in the control group. Patients that received no IPC treatment exhibited an almost threefold increased odds for DVT, independently of age. Furthermore, using microdialysis technique, adjuvant IPC treatment was shown to increase the metabolic healing activity at 2 weeks post-ATR.

Tendon healing is impaired by reduced circulation and DVT. The demonstration that adjuvant IPC effectively reduced DVT incidence, and also is capable of enhancing the metabolic response suggests that IPC treatment may not only be a viable means of prophylaxis against DVT, but possibly also a method of promoting healing.

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Abbreviations

ACOS:

Achilles Combined Outcome Score

ATR:

Achilles Tendon Rupture

ATRS:

Achilles tendon Total Rupture Score

BMI:

Body Mass Index

CDS:

Color Duplex Sonography

CDU:

Compression Duplex Ultrasound

DVT:

Deep Venous Thrombosis

EQ-5DTM :

EuroQol, a generic health-related quality of life score

IPC:

Intermittent Pneumatic Compression

LSI:

Limb Symmetry Index

PAS:

Physical Activity Scale

RR:

Relative Risk or Risk Ratio

VTE:

Venous Thromboembolism

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Author information

Authors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden

    Erica Domeij-Arverud & Paul W. Ackermann

  2. Department of Orthopedic Surgery, Danderyd Hospital, Stockholm, SE-17176, Sweden

    Erica Domeij-Arverud

  3. Department of Orthopedic Surgery, Karolinska University Hospital, SE-17176, Stockholm, Sweden

    Paul W. Ackermann

Authors
  1. Erica Domeij-Arverud
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  2. Paul W. Ackermann
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Corresponding author

Correspondence to Erica Domeij-Arverud .

Editor information

Editors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Paul W. Ackermann

  2. McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada

    David A. Hart

Glossary

Concentric muscle contraction

When a muscle shortens while producing a force

Eccentric muscle contraction

When a muscle lengthens while producing a force

Heel-rise

The exercise in which the subject performs a plantar flexion when standing and back down again

Incidence

The number of new cases of a condition/injury that develop during a specific time period

LSI

The ratio of the involved limb score and the uninvolved limb score expressed in percent (involved/uninvolved x 100 = LSI)

Predictor

The independent variable used to explain or to predict the outcome variable

Risk factor

A variable associated with an increased risk of injury or disease

Work

The product of a constant force and the distance the object is moved in the direction of the force (J)

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Domeij-Arverud, E., Ackermann, P.W. (2016). Deep Venous Thrombosis and Tendon Healing. In: Ackermann, P., Hart, D. (eds) Metabolic Influences on Risk for Tendon Disorders. Advances in Experimental Medicine and Biology, vol 920. Springer, Cham. https://doi.org/10.1007/978-3-319-33943-6_21

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