Patients with acute Achilles tendon rupture (ATR) display an extended healing process with varying clinical outcome. Poor microcirculatory blood flow has been suggested to be a significant factor for the healing process. However, whether microcirculation may predict healing outcome has been mostly unknown. Therefore, we investigated whether blood flow in the Achilles tendon may be associated with patient‐reported and functional outcomes after ATR. In vivo laser‐Doppler flowmetry was used to assess microvascular blood flow bilateral in the Achilles tendons, during post‐occlusive reactive hyperemia, of nine patients with acute total ATR at 2 weeks post‐operatively. At 3 months post‐operatively, patient‐reported outcome was assessed using Achilles tendon Total Rupture Score (ATRS). At 1 year a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining validated, independent, patient‐reported (ATRS), and functional outcome (heel‐rise test) measures. An improved combined patient‐reported and functional outcome, ACOS, at 1 year was significantly correlated with higher maximum blood flow (r=.777, P=.040) in the injured limb. Furthermore, enhanced patient‐reported outcome, ATRS, at 3 months, was associated with an elevated ratio of maximum to resting blood flow (r=.809, P=.015) in the uninjured limb. Blood flow in early tendon healing is associated with long‐term patient‐reported and functional outcomes after ATR. The microcirculatory blood flow of both the healing and contralateral Achilles tendon seems to determine the healing potential after injury.

Stimulation of venous return is critical for prevention of venous thromboembolism; however, an optimized treatment modality has yet to be defined. Therefore, the main objective of this study was to investigate and compare the hemodynamic effects and the second aim was to assess tolerability of three different intermittent pneumatic compression (IPC) devices, foot‐IPC, rapid, and slow calf‐IPC, and the recently developed technology of calf neuromuscular electric stimulation (NMES). The blood flow in the right popliteal vein was assessed with Doppler ultrasound in 10 healthy individuals in semirecumbent position without (baseline) and with each of the IPC‐ and NMES treatment devices. Comfort assessment was completed using visual analogue scale for each treatment modality. All treatments significantly increased peak velocity (PV), mean velocity (MV) volume flow (VF) and ejected volume per individual stimulus (EV) as compared to baseline. Rapid calf‐IPC caused the most profound hemodynamic effects with a mean effect size 2.06, taking into account all the above hemodynamic parameters compared to baseline. The weakest response was observed with foot‐IPC with a mean effect size 1.50 compared to baseline. All devices compressing the calf produced higher hemodynamic values (mean effect size: 1.89 slow calf‐IPC and 1.58 NMES) compared to foot‐IPC. Comfort assessment demonstrated unacceptable tolerability for NMES, while the other devices showed an acceptable tolerability. Augmentation of venous return using calf‐ compared to foot devices is hemodynamically superior. Varying hemodynamic responses are observed between calf blood flow stimulating devices. The low tolerability of NMES, however, may limit its clinical applicability.

Proximal median nerve compression can be seen in association with cubital tunnel syndrome. Careful evaluation of the reported symptoms as well as thorough clinical examination are the keystone of the correct diagnosis. Also, on the basis of this study, we believe that concurrent decompression can be performed through a single medial incision, though extensive dissection may be required.