Paul Ackermann

Paul Ackermann
Karolinska Institutet | KI · Department of Molecular Medicine and Surgery

MD, PhD
Looking for collaborators with the STOP Leg Clots (SLC) Trial, both in Sweden and Internationally. https://ki.se/en/mmk/

About

132
Publications
21,303
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Introduction
Currently we are focusing our efforts on a multicenter study with the aim to reduce the number of adverse events, i.e. venous thromboembolism (VTE) and failed healing in association with lower limb immobilization. We aim in leg immobilized patients to demonstrate that adjuvant intermittent pneumatic compression (IPC) therapy, which targets impaired vascular flow, compared to treatment-as-usual with plaster cast, reduces VTE-incidence and improves healing. My mission in research is to understand and exploit neuro-vascular pathways in the musculo-skeletal system for restoring joint function, alleviating pain and minimizing complications.
Additional affiliations
August 2012 - present
Karolinska University Hospital
Position
  • Consultant
March 2011 - present
Karolinska Institutet
Position
  • Compression treatment for DVT prevention
Description
  • IPC, DVT, Achilles tendon rupture ClinicalTrials.gov Identifier: NCT01317160
January 2009 - present
Karolinska Institutet
Position
  • Professor (Associate)

Publications

Publications (132)
Article
Dense connective tissue healing, such as tendon, is protracted leading to highly variable and unsatisfactory patient outcomes. Biomarkers prognostic of long‐term clinical outcomes is, however, unknown. The present study was designed to investigate the proteomic profile of healing, identify potential biomarkers, and assess their association with the...
Article
Full-text available
Purpose To investigate whether Neuromuscular Electrical Stimulation (NMES) simultaneously applied on the quadriceps (Q) and gluteal (G) muscles, as compared to single Q-stimulation alters the knee extensor force production and discomfort. Methods A total of 11 healthy participants (6 females), with normal weight and age between 19 and 54 years wer...
Article
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Recommendations from the ICM-VTE General Delegates.
Article
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Background The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown. Purpose To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons. Study Design Coho...
Article
Full-text available
Background Neuromuscular electrical stimulation (NMES) may prevent muscle atrophy, accelerate rehabilitation and enhance blood circulation. Yet, one major drawback is that patient compliance is impeded by the discomfort experienced. It is well-known that the size and placement of electrodes affect the comfort and effect during high-intensity NMES....
Preprint
Full-text available
Background: Contractions of muscles in the calf induced by neuromuscular electrical stimulation (NMES) may prevent venous thromboembolism. However, compliance to NMES-treatment is limited by the use of suboptimal stimulation points which may cause discomfort. Knowledge of where one is most likely to find muscle motor points (MP) could improve NMES...
Preprint
Full-text available
Background: Neuromuscular electrical stimulation (NMES) may improve venous hemodynamics to decrease the risk of venous thromboembolism. However, whether calf-NMES using textile electrodes integrated in socks can improve venous hemodynamics without discomfort is unknown. Aim: The primary aim of this study was to examine whether calf-NMES, using one...
Article
Full-text available
Purpose Healing outcome after Achilles Tendon Rupture (ATR) is variable and unsatisfactory. Many ATR patients still exhibit pain, functional deficits and limitations in walking one-year post-surgery. The present study was designed to investigate the association between the expression of healing biomarkers and patient outcome after ATR. Methods Ten...
Conference Paper
The major reason for preventable hospital death is venous thromboembolism (VTE). Non-pharmacological treatment options include electrical stimulation or compression therapy to improve blood flow in the extremities. Textile electrodes offer potential to replace bulky devices commonly used in this field, thereby improving the user compliance. In this...
Article
Full-text available
This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mea...
Article
Full-text available
Introduction Leg immobilisation in a cast or an orthosis after lower limb injuries is associated with a high risk of complications of venous thromboembolism (VTE) and hampered healing. Current pharmacoprophylaxes of VTE are inefficient and associated with adverse events. Intermittent pneumatic compression (IPC) could represent a novel, efficient an...
Article
Full-text available
Following publication of this article [1], the authors report the following Corrections to the main text: i) The authors noticed that the reported number of patients that were treated surgically were too many (n = 363) and have corrected the numbers (n = 337). Patients from the cohort Nilsson-Helander et al. [2] were incorrectly labeled as surgical...
Article
Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated wi...
Article
PurposeTo examine healing adaptations over 17 weeks post Achilles tendon (AT) rupture in the injured region (IR) compared to an uninjured region (UIR) of the AT.Methods Twenty-four rats were subjected to a complete right-sided AT rupture, while the left side served as a control. ATs were harvested at 1, 2, 8 and 17 weeks post-rupture and stained wi...
Article
Full-text available
Background: While numerous clinical studies have compared the surgical and non-surgical treatment of acute Achilles tendon rupture (ATR), there are no studies that have performed a non-inferiority analysis between treatments. Methods: Data from patients who were included in five randomised controlled trials from two different centres in Sweden w...
Article
Full-text available
PurposeThe primary aim of this study was to assess the relationship between the metabolites lactate and pyruvate in the healing tendon after Achilles tendon rupture (ATR) and patient-reported outcome at 6 and 12 months. A secondary aim was to evaluate which underlying factors regulate lactate and pyruvate concentrations.Methods Lactate and pyruvate...
Article
Full-text available
PurposeAchilles tendon rupture (ATR) is a common injury. The knowledge of seasonal factors´ impact is incomplete, but may provide means for preventive approaches for Achilles tendon related morbidity. The aim of this study was to investigate seasonal variations in ATR incidence in relation to injury mechanism, adverse events including risk of re-ru...
Article
Full-text available
PurposeThe aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization.MethodsA cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with a...
Article
Full-text available
Mast cells are emerging as players in the communication between peripheral nerve endings and cells of the immune system. However, it is not clear the mechanism by which mast cells communicate with peripheral nerves. We previously found that mast cells located within healing tendons can express glutamate receptors, raising the possibility that mast...
Article
Full-text available
Background Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impac...
Article
Full-text available
Purpose The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. Methods One-hundred and fifty patients with...
Article
Full-text available
Background Acute Achilles tendon rupture (ATR) is a frequently disabling injury, which exhibits unclear variability in long‐term functional and patient‐reported outcomes. Biomarkers from early healing, which have been shown to be prognostic of long‐term outcome would facilitate the development of improved treatment methods. Hypothesis/Purpose The...
Article
Full-text available
Purpose The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1 year after an Achilles tendon rupture. Methods This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to t...
Article
Objective:. Many trauma patients are at risk of pulmonary embolism due to unrecognized deep vein thrombosis (DVT). Restricted ankle dorsiflexion (AD) range of motion during leg immobilization is known to cause reduced venous blood flow. The aim of the present study was to assess whether AD at plaster cast removal is related to the incidence of DVT...
Article
Background:: Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown. Purpose:: The primary aim of this study...
Article
Full-text available
The aim of this study was to compare the treatment effects of laser photobiomodulation (LPBM) therapy and aerobic exercise on the biomechanical properties, tissue morphology and the expression of tendon matrix molecules during early remodeling of Achilles tendon (AT) injury in diabetic rats. Animals were randomly assigned to five groups: injured no...
Data
The AT partial tenotomy injury model with an 18-gauge needle. (TIF)
Data
The moderate aerobic exercise protocol in a motorized treadmill. (MP4)
Article
Achilles tendinopathy (AT) is a continued enigma for clinicians from all parts around the world. The increasing prevalence is related to physical activities, but additionally also to metabolic factors unrelated to activities that load the Achilles tendon. AT can comprise two different diagnosis: insertional AT and non-insertional AT (NIAT). This re...
Preprint
Full-text available
Achilles Tendon Rupture (ATR) is one of the typical soft tissue injuries. Rehabilitation after such a musculoskeletal injury remains a prolonged process with a very variable outcome. Accurately predicting rehabilitation outcome is crucial for treatment decision support. However, it is challenging to train an automatic method for predicting ATR reha...
Article
Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To de...
Article
Achilles tendinopathy (AT), which is increasing in prevalence, continues to puzzle clinicians around the world. AT comprises insertional and non-insertional AT (NIAT). This review will deal with NIAT, which is often related to changes in activities in sports and occupation, but can also be unrelated to activities that load the Achilles tendon. Rece...
Preprint
Full-text available
Missing data are ubiquitous in many domains such as healthcare. Depending on how they are missing, the (conditional) independence relations in the observed data may be different from those for the complete data generated by the underlying causal process and, as a consequence, simply applying existing causal discovery methods to the observed data ma...
Conference Paper
Full-text available
Achilles Tendon Rupture (ATR) is one of the typical soft tissue injuries. Accurately predicting the rehabilitation outcome of ATR using noisy measurements with missing entries is crucial for treatment decision support. In this work, we design a probabilistic model that simultaneously predicts the missing measurements and the rehabilitation outcome...
Chapter
Targeted therapies of elbow tendinopathies have been limited due to lack of knowledge of the underlying pathophysiology. Recreational tennis players are mostly affected by the classical “tennis elbow”––humeral epicondylar lateral tendinopathy, while elite tennis players more commonly present with medial humeral epicondylar tendinopathy, reflecting...
Article
Full-text available
The role of inflammation and the mechanism of tendon healing after rupture has historically been a matter of controversy. The purpose of the present study is to investigate the role of mast cells and their relation to the NMDA receptor-1 (a glutamate receptor) during healing after Achilles tendon rupture. Eight female Sprague Dawley rats had their...
Article
Background: Headache is one of the most prevalent disorders worldwide, causing severe pain and functional impairment in sufferers. Impairments of quality of life as well as considerable costs due to various expensive treatments are the consequences. This study assesses the following question: Is chiropractic treatment of headaches, in comparison to...
Article
Full-text available
Purpose and hypothesis: Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing. Methods: One hundred and fifty patients with surgical re...
Article
Purpose: The relationship between the duration of operative time (DOT), healing response and patient outcome has not been previously investigated. An enhanced healing response related to DOT may potentiate repair processes, especially in hypovascular and sparsely metabolized musculoskeletal tissues such as tendons. This study aimed to investigate...
Article
Background: The aim was to investigate whether exercise training (ExT) would ameliorate expression of key genes for myocardial morphostructure and mitigate adverse left ventricular (LV) remodeling in experimental type 1 diabetes (T1D). Methods and results: Male Wistar rats were divided into four groups: sedentary control (SC, n=9), trained contr...
Chapter
Tendon healing entails five essential and overlapping processes, which each has to be mastered and optimized to achieve good patient outcome. These five sequences of tendon repair can be defined as follows: (1) Induction, (2) Production, (3) Orchestration, (4) Conduction and (5) Modification. Biological enhancement of the healing process with novel...
Article
Introduction: 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...
Article
BACKGROUND: Tendinopathy, both sports and work related, is increasing in prevalence. Evidence-based treatment options for tendinopathy, however, have been scarce. Here we provide a systematic review, updated on the current treatment options for tendinopathy. EVIDENCE ACQUISITION: References for this systematic review were searched in June 2016 with...
Article
Full-text available
Metabolic diseases such as diabetes mellitus type-II (DM-II) may increase the risk of suffering painful connective tissue disorders and tendon ruptures. The pathomechanisms, however, by which diabetes adversely affects connective tissue matrix metabolism and regeneration, still need better definition. Our aim was to study the effect of DM-II on exp...
Article
Full-text available
Imputing incomplete medical tests and predicting patient outcomes are crucial for guiding the decision making for therapy, such as after an Achilles Tendon Rupture (ATR). We formulate the problem of data imputation and prediction for ATR relevant medical measurements into a recommender system framework. By applying MatchBox, which is a collaborativ...
Article
Aims: Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions. Patients and methods: A tot...
Chapter
Painful and non-healing musculoskeletal disorders, eg. tendinopathy, pose a tremendous burden on society and the quality of life for patients. New advances in the understanding of connective tissue disorders such as tendinopathy reveal that common health problems such as obesity, atherosclerosis, hormonal dysfunctions and diabetes mellitus are clos...
Chapter
The regulation of tendon metabolism including the responses to loading is far from being well understood. During the last decade, however, accumulating data show that tendon innervation in addition to afferent functions, via efferent pathways has a regulatory role in tendon homeostasis via a wide range of neuromediators, which coordinate metabolic...
Chapter
Tendon metabolism after acute Achilles tendon rupture (ATR) is associated with major complications related to immobilization, which results in reduced circulation, high risk of deep venous thrombosis (DVT), impaired healing and functional deficits. DVT has been demonstrated to occur in up to 50 % of the patients with ATR. Suffering from a DVT durin...
Article
Full-text available
PurposeFunctional weight-bearing mobilization may improve repair of Achilles tendon rupture (ATR), but the underlying mechanisms and outcome were unknown. We hypothesized that functional weight-bearing mobilization by means of increased metabolism could improve both early and long-term healing. Methods In this prospective randomized controlled tria...
Article
Full-text available
Objective Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon...
Article
Full-text available
Purpose To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients. Methods Following a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme an...
Book
This book will be of considerable interest to students, practitioners (Doctors, Physiotherapists, and other health care professionals), and researchers who deal with the complex structure of tendons and the need to effectively address tendon disorders. The book is divided into three sections: (1) Basic Biology and Biochemical Markers; (2) Metabolic...
Chapter
Tendinopathy is a disorder increasing in prevalence and its treatment involves a huge effort from patient and therapist.
Article
Aim: Tendinopathy, both sports and work related, is increasing in prevalence also because of underlying recently discovered relationship to metabolic disorders. Google "tendon treatment" and you will get more than 26,000,000 hits; however, evidence-based treatment options for tendinopathy have been scarce. Methods: A MEDLINE search on tendinopathy,...
Article
Full-text available
The recent discovery of residing tendon stem/progenitor cells has triggered a growing interest in stem cells as a useful tool in tendon repair. Our knowledge of their involvement in naturally healing tendons is, however, sparse. The aim of this study was to identify and determine stem/progenitor cells in relation to different healing phases and reg...