Aufwerber, SusannaSvedman, SimonGrävare Silbernagel, KarinAckermann, Paul W.2024-06-122024-06-122024-05-24Aufwerber, S., Svedman, S., Silbernagel, K.G. & Ackermann, P.W. (2024) Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair. Knee Surgery, Sports Traumatology, Arthroscopy, 1–10. https://doi.org/10.1002/ksa.122401433-7347https://udspace.udel.edu/handle/19716/34486This article was originally published in Knee Surgery, Sports Traumatology, Arthroscopy. The version of record is available at: https://doi.org/10.1002/ksa.12240. © 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.Purpose The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. Methods This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). Results In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. Conclusions DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. Level of Evidence Level Ⅲ. Abbreviations ATR Achilles tendon rupture ATRS Achilles tendon Total Rupture Score BMI body mass index CDU compression duplex ultrasound DVT deep venous thrombosis EFM early functional mobilization IPC intermittent pneumatic compression LMWH low-molecular-weight heparin LSI limb symmetry index PAS Physical Activity Scale RCT randomized controlled studyen-USAttribution 4.0 InternationalArticle