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Randomized Controlled Trial
. 2020 Jan;28(1):312-319.
doi: 10.1007/s00167-019-05767-x. Epub 2019 Nov 2.

Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Susanna Aufwerber  1   2 , Annette Heijne  3 , Gunnar Edman  4   5 , Karin Grävare Silbernagel  6 , Paul W Ackermann  7   8
Affiliations
Randomized Controlled Trial

Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Susanna Aufwerber et al. Knee Surg Sports Traumatol Arthrosc. 2020 Jan.

Abstract

Purpose: The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT.

Methods: 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. At 2 and 6 weeks postoperatively, all patients were screened for DVT using compression duplex ultrasound. During the first 2 weeks postoperatively, patient-reported loading, pain and step counts were assessed.

Results: 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 (n.s). During the first postoperative week, the early functional mobilization group reported low loading and higher experience of pain vs. the control group (p = 0.001). Low patient-reported loading ≤ 50% (OR = 4.3; 95% CI 1.28-14.3) was found to be an independent risk factor for DVT, in addition to high BMI and higher age.

Conclusions: Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to treatment-as-usual. The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing. To minimize the risk of DVT, patients should be encouraged to load at least 50% of body weight on the injured leg 1 week after surgery.

Level of evidence: Therapeutic, level 1.

Keywords: Achilles tendon; Duplex ultrasonography; Rupture; Venous thrombosis; Weightbearing.

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Conflict of interest statement

The author Ackermann has received research grants from OPED Gmbh.

Figures

Fig. 1
Fig. 1
CONSORT flowchart
Fig. 2
Fig. 2
Weightbearing and risk of DVT. DVT deep venous thrombosis
See this image and copyright information in PMC

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