Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture

Bone Joint J. 2016 Dec;98-B(12):1635-1641. doi: 10.1302/0301-620X.98B12.BJJ-2016-0008.R1.

Abstract

Aims: Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions.

Patients and methods: A total of 111 patients (95 men, 16 women; mean age 40.3, standard deviation 8.4) with an acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Predictors of ACOS included treatment; gender; age; smoking; body mass index; time to surgery; physical activity level pre- and post-injury; symptoms; quality of life and incidence of DVT.

Results: There were three independent variables that correlated significantly with the dichotomised outcome score (ACOS), while there was no correlation with other factors. An age of less than 40 years old was the strongest independent predictor of a good outcome one year after ATR (odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08 to 0.51), followed by female gender (OR) 4.18, 95% CI 1.01 to 17.24). Notably, patients who did not have a DVT while immobilised post-operatively had a better outcome (OR 0.31, 95% CI 0.12 to 0.80).

Conclusion: Over the age of 40 years, male gender and having a DVT while immobilised are independent negative predictors of outcome in patients with an acute ATR. Cite this article: Bone Joint J 2016;98-B:1635-41.

Keywords: Achilles tendon rupture; Ageing; Deep venous thrombosis; Functional outcome; Gender; Intermittent pneumatic compression; Predictors.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Achilles Tendon / injuries*
  • Achilles Tendon / surgery
  • Acute Disease
  • Adult
  • Age Factors
  • Ankle Joint / physiopathology
  • Casts, Surgical
  • Female
  • Humans
  • Intermittent Pneumatic Compression Devices
  • Male
  • Middle Aged
  • Orthotic Devices
  • Postoperative Care / methods
  • Postoperative Complications / prevention & control
  • Postoperative Complications / rehabilitation*
  • Prognosis
  • Prospective Studies
  • Recovery of Function
  • Risk Factors
  • Sex Factors
  • Tendon Injuries / rehabilitation*
  • Tendon Injuries / surgery
  • Treatment Outcome
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control
  • Venous Thrombosis / rehabilitation*