Our Summary

When someone tears their Achilles tendon, they often have to keep their leg immobilized while it heals. Unfortunately, this lack of movement can lead to problems like poor blood flow, a high risk of blood clots (deep venous thrombosis or DVT), slower healing, and long-term issues with how the leg functions.

In fact, about half of the people who tear their Achilles tendon also get a DVT. This is a big problem because having a DVT while your tendon is healing can make your outcome a year after the injury worse.

Doctors have tried using medicine to prevent DVTs, but it doesn’t always work when the leg is immobilized. So, researchers decided to test a different approach: using a device that applies intermittent pneumatic compression (IPC) during the healing process.

IPC works by periodically inflating a cuff around the leg to improve blood flow. This method has shown promise in other studies, helping nerves and blood vessels grow into the healing tendon and boosting the production of collagen, a protein that strengthens the tendon as it heals.

In a recent trial, researchers compared people who had a torn Achilles tendon and used IPC under a brace to those who only had a plaster cast. They found that after two weeks, 21% of the people using IPC had a DVT compared to 37% in the plaster cast group. In other words, people who didn’t use IPC were almost three times more likely to get a DVT, regardless of their age.

Additionally, the researchers discovered that using IPC increased the healing activity in the tendon two weeks after the tear.

In simple terms, these findings suggest that using IPC not only helps prevent DVTs in people with torn Achilles tendons, but it might also speed up the healing process.

FAQs

  1. What are the major complications associated with tendon metabolism after acute Achilles tendon rupture?
  2. How does intermittent pneumatic compression (IPC) aid in the healing process after an Achilles tendon rupture?
  3. What are the potential benefits of using IPC treatment during lower limb immobilization after an Achilles tendon rupture?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tendon repair is to consider using adjuvant intermittent pneumatic compression (IPC) therapy to reduce the risk of deep venous thrombosis (DVT) and enhance tendon healing. IPC has been shown to improve circulation, stimulate collagen production, and enhance metabolic healing activity, potentially leading to better outcomes after tendon repair surgery. It is important to discuss this option with your healthcare provider to see if it is appropriate for your specific situation.

Suitable For

Patients who have suffered from an acute Achilles tendon rupture (ATR) are typically recommended tendon repair. These patients are at high risk for complications related to immobilization, such as reduced circulation, deep venous thrombosis (DVT), impaired healing, and functional deficits. Studies have shown that DVT occurs in up to 50% of patients with ATR and can significantly impact patient outcomes.

In order to prevent DVT and improve tendon healing, adjuvant treatment with intermittent pneumatic compression (IPC) applied during lower limb immobilization may be recommended. IPC has been shown to enhance neuro-vascular ingrowth, stimulate collagen production, and improve maximum force during healing. A recent study found that adjuvant IPC treatment reduced the incidence of DVT in ATR patients compared to those who did not receive IPC treatment.

Overall, patients with ATR who are at risk for complications related to immobilization may benefit from tendon repair and adjuvant treatment with IPC to prevent DVT and promote healing.

Timeline

  • Before tendon repair: The patient may experience acute Achilles tendon rupture, leading to immobilization and reduced circulation. There is a high risk of deep venous thrombosis (DVT) and impaired healing. DVT has been shown to occur in up to 50% of patients with ATR, and it is a predictive factor for impaired patient outcome at 1 year after ATR.

  • After tendon repair: A prospective randomized trial compared adjuvant intermittent pneumatic compression (IPC) applied under an orthosis versus plaster cast only in ATR patients. The study found a lower incidence of DVT in the IPC group compared to the control group at 2 weeks post-operatively. Adjuvant IPC treatment was shown to increase metabolic healing activity at 2 weeks post-ATR, suggesting that IPC treatment may not only be a viable means of DVT prophylaxis but also a method of promoting healing.

What to Ask Your Doctor

  1. Can adjuvant treatment with intermittent pneumatic compression (IPC) reduce the risk of deep venous thrombosis (DVT) after tendon repair surgery?
  2. How does IPC work to enhance tendon healing and reduce the incidence of DVT?
  3. Are there any potential side effects or risks associated with using IPC after tendon repair surgery?
  4. How soon after surgery can IPC be started, and for how long should it be continued?
  5. Will IPC treatment affect the overall outcome and recovery time after tendon repair surgery?
  6. Are there any other preventative measures or treatments that should be considered in addition to IPC for reducing the risk of DVT after tendon repair surgery?

Reference

Authors: Domeij-Arverud E, Ackermann PW. Journal: Adv Exp Med Biol. 2016;920:221-8. doi: 10.1007/978-3-319-33943-6_21. PMID: 27535264