title: Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Karolinska Institutet, Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden.
authors.forename: E Domeij-
authors.initials: ED
authors.lastname: Arverud
authors.affiliation: Karolinska Institutet, Department of Orthopaedics, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Anundsson
authors.affiliation: Karolinska Institutet, Capio Artro Clinic, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Hardell
authors.affiliation: Karolinska Institutet, Capio Artro Clinic, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Barreng
authors.affiliation: Karolinska Institutet, Tiohunder Hospital, Norrtälje, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Edman
authors.affiliation: Karolinska Institutet, Section of Diagnostic Imaging, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Latifi
authors.affiliation: Karolinska Institutet, Section of Diagnostic Imaging, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Labruto
authors.affiliation: Karolinska Institutet, Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: P W
authors.initials: PW
authors.lastname: Ackermann
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000843:Ankle Joint / Q000503:physiopathology; D002370:Casts, Surgical; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control / Q000534:rehabilitation*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012737:Sex Factors; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control / Q000534:rehabilitation*
keywords: Achilles tendon rupture; Ageing; Deep venous thrombosis; Functional outcome; Gender; Intermittent pneumatic compression; Predictors