title: Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism.
abstract: BACKGROUND
  Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis.
  
  
  METHODS
  One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures.
  
  
  RESULTS
  Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery.
  
  
  CONCLUSIONS
  In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE.
  
  
  METHODS
  Prognostic, Level III: Case Control Study.
authors.affiliation: Saginaw Valley Bone and Joint Center, Saginaw, Michigan (MJB).|The Orthopedic Group, Belle Vernon, Pennsylvania (WTD, MHH).|Northwest Podiatrists, Portland, Oregon (JDT).
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bullock
authors.affiliation: Saginaw Valley Bone and Joint Center, Saginaw, Michigan (MJB).|The Orthopedic Group, Belle Vernon, Pennsylvania (WTD, MHH).|Northwest Podiatrists, Portland, Oregon (JDT).
authors.forename: William T
authors.initials: WT
authors.lastname: DeCarbo
authors.affiliation: Saginaw Valley Bone and Joint Center, Saginaw, Michigan (MJB).|The Orthopedic Group, Belle Vernon, Pennsylvania (WTD, MHH).|Northwest Podiatrists, Portland, Oregon (JDT).
authors.forename: Mark H
authors.initials: MH
authors.lastname: Hofbauer
authors.affiliation: Saginaw Valley Bone and Joint Center, Saginaw, Michigan (MJB).|The Orthopedic Group, Belle Vernon, Pennsylvania (WTD, MHH).|Northwest Podiatrists, Portland, Oregon (JDT).
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Thun
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
keywords: Achilles rupture; Achilles tendonitis; chronic Achilles rupture; deep vein thrombosis; venous thromboembolism