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13 Deep vein thrombosis after acute achilles tendon rupture. An RCT comparing early controlled motion of the ankle with no motion
  1. Kristoffer Weisskirchner Barfod1,
  2. Emil Nielsen2,
  3. Beth Hærsted Olsen2,
  4. Pablo Gustavo Vinicoff2,
  5. Anders Troelsen3,
  6. Per Holmich1
  1. 1Sports Orthopedic Research Center – Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  2. 2Department of Radiology, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  3. 3Department of Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark


Background Deep vein thrombosis (DVT) following acute Achilles tendon rupture (ATR) is common (up to 34%) and potentially dangerous. Immobilization (IM) is thought to be an important factor in the pathogenesis.

Purpose of the study To investigate if early controlled ankle motion ECM could reduce the incidence of DVT compared to IM in the treatment of acute Achilles tendon rupture.

Materials and methods The study was performed as a randomized controlled trial. Patients aged 18 to 70 years were eligible for inclusion. Treatment was non-operative. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was IM for 8 weeks. Follow up was performed with Color Doppler ultrasound at 2 and 8 weeks by two experienced radiologists. DVT was a secondary outcome, why a secondary power calculation was performed: 124 patients were required to have a 60% chance of detecting, as significant at the 5% level, a decrease in DVT from 34% in the IM group to 17% in the ECM group.

Findings/results 189 patients were assessed for eligibility and 130 randomized: 68 (ECM-group) and 62 (IM-group). All patients participated in the follow up. 62 (47.7%) patients were diagnosed with DVT; 34/69 (49.3%) in the ECM group and 28/61 (45.9%) in the IM group (p=0.70).

Conclusions The incidence of asymptomatic DVT was higher than previously reported as 48% presented with DVT. ECM revealed no benefit to IM in reducing the incidence of DVT.

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