Deep Vein Thrombosis after Achilles Tendon Repair: A Case Report

Abstract

a smoker and had a body mass index (BMI) of 27.14 kg/m 2. No hereditary prothrombotic conditions were known to afflict the patient himself or his relatives. On physical examination, Thompson squeeze test was positive but palpable gap between the ruptured proximal end and distal end of left Achilles tendon was not clear. Magnetic resonance imaging revealed partial transverse rupture of distal two third of lateral portion which is 7.5 cm distant from the calcaneal attachment site (Fig. 1). The patient agreed to undergo surgical repair and on the following day, operation was done. He underwent surgery under spinal anesthesia, and a tourniquet was inflated for seventy-four minutes. Skin incision along medial border of Achilles tendon was made and distal one third of medial portion of the Achilles tendon was ruptured at mid calf. We tried to pass the medial portion of the Achilles tendon proximally through the paratenon after island incision was made on ruptured site. However, it failed thus we prolonged incision to repair the tendon (Fig. 2). The tendon was sutured using a modified Krackow technique and additional side-to-side interrupted suture. The patieint was subsequently immobilized in a short leg cast in a plantar flexed position and was sent home 4 days after the operation on crutches. Two weeks postoperatively, the patient visited the outpatient clinic to remove the stitch and change the cast into a ninety degree position of ankle. Surgical wound was clean and no clinical problem was found. However, approximately 3 weeks postoperatively, Achilles tendon ruptures are common and the incidence of Achilles tendon rupture is reported variably from 18 to 37.3 per 100,000. 1,2) Both operative and non-operative treatments of Achil-les tendon rupture include a period of immobilization which is a risk factor for deep vein thrombosis (DVT). 3) DVT is an important source of morbidity in orthopaedic surgery and can progress to pulmonary embolism (PE) which is a significant source of mortality. The rates of reported DVT in patients with Achilles tendon rupture range from less than 1% to 34%. 4) However, DVT after the Achilles tendon repair have not yet been reported. Here, we report a case of DVT following Achilles tendon repair that required angiointervention to remove the thrombus. CASE REPORT A 49-year-old male presented to our institution with a painful left heel after playing soccer. He complained about difficulty in walking. He had been taking amlodipine 5 mg per day for 2 years to control his hypertension and had a history of Achilles tendon repair in the right ankle 7 years prior to current injury. He was not Case Report CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Achilles tendon rupture is thought to be increasing with participation in sports activities. Both operative and non-operative treatments of Achilles tendon rupture include a period of immobilization. Complications following treatment of the Achilles tendon rupture include recurrence of rupture, flexor weakness, infection, and wound problems. However, deep vein thrombosis (DVT) after operative treatment of the Achilles tendon has not been reported. We report on a case of DVT after Achilles tendon repair.