Epidemiology of Achilles Tendon Ruptures in the United States: Athletic and Nonathletic Injuries From 2012 to 2016

Abstract

Background:Achilles tendon (AT) ruptures are one of the most common tendon ruptures, but there have been no studies investigating these injuries in the United States (US) using data representative of the entire US population.Purpose/Hypothesis:The purpose of this study was to determine the incidence and risk factors for AT ruptures in the US. We hypothesized that male sex, older age, and sport participation would increase the risk for AT ruptures.Study Design:Descriptive epidemiology study.Methods:All patients presenting to an emergency department with ruptured AT in the US from 2012 through 2016 were selected from the National Electronic Injury Surveillance System (NEISS) database. Incidence was calculated for sex, race, and age. AT ruptures were characterized based on the mechanism of injury, with subanalyses performed on sport-related AT ruptures to examine sex-, race-, and age-related differences.Results:From 2012 to 2016, a significant increase in the incidence of AT ruptures was observed, from 1.8 per 100,000 person-years in 2012 to 2.5 per 100,000 person-years in 2016 (P < .01), for an overall incidence of 2.1 per 100,000 person-years. The majority of AT ruptures occurred in male compared with female patients, with an incidence rate ratio of 3.5 (P < .01). The largest overall incidence of AT ruptures occurred in those aged 20-39 years for male patients (5.6/100,000 person-years) and in those aged 40-59 years for female patients (1.2/100,000 person-years). The largest rise in the incidence of AT ruptures during the study period was observed in patients aged 40-59 years (78% increase). The most common injury mechanism was participation in a sport or recreational activity (81.9% of all injuries), with basketball being the most common overall cause of AT ruptures.Conclusion:While AT ruptures in the US most commonly occur in young male patients (20-39 years old), the largest rise in the incidence was observed in middle-aged patients (40-59 years old), with participation in recreational sports being the most likely mechanism. Recognizing high-risk patients can help physicians counsel them and recommend strategies for injury prevention.

Models of tendon development and injury

“…Adult tendon contains a dense network of aligned and continuous collagen fibrils that are responsible for force transmission [102,103]. Unfortunately, the incidence of tendon ruptures is increasing [1,104,105], and tendon heals as disorganized scar tissue that does not regain mechanical function [2,106]. A major challenge has been a limited understanding of the numerous factors that influence tendon injury (e.g., tendinopathy and ruptures) and healing.…”

Diffusion Weighted Magnetic Resonance Imaging of the Achilles tendon and Related Pathology: Qualitative & Quantitative Investigation

“…Axial SE-EPI-DW test sequences were then acquired with diffusion complete to spontaneous ruptures of the AT are noticed [2]. Research has shown that acute AT ruptures occur predominantly in men between 30 and 50 years of age, in association with intermittent sports activity [3]. The aetiology of tendinopathy of the AT is known to be multifactorial, with many cases occurring suddenly, without any preceding signs or symptoms.…”

Engineering the Tenogenic Niche In Vitro with Microenvironmental Tools

“…[2] The Achilles tendon is DOI: 10.1002/adtp.201900072 one of the most commonly injured tendons with between 7 and 40 incidences occurring per 100 000 people every year. [3] Rotator cuff pathology has been reported to be as high as 87 incidences per 100 000 people every year in the UK population. [4] Achilles tendon injuries frequently occur during recreational activities, [3] while hand and wrist tendon injuries affect primarily the working population and occur at a rate of 33 incidences per 100 000 people every year.…”

“…[3] Rotator cuff pathology has been reported to be as high as 87 incidences per 100 000 people every year in the UK population. [4] Achilles tendon injuries frequently occur during recreational activities, [3] while hand and wrist tendon injuries affect primarily the working population and occur at a rate of 33 incidences per 100 000 people every year. [5] 84% of the Achilles ruptures occur in men, [6] with recent studies suggesting that hormones are responsible for the higher resistance of females to tendon injuries.…”

“…[5] 84% of the Achilles ruptures occur in men, [6] with recent studies suggesting that hormones are responsible for the higher resistance of females to tendon injuries. [7] The ever increasing active lifestyle is associated with a reported 900% increase in Achilles tendon ruptures from 1979 to 2011 [8] and a 39% increase from 2012 to 2016; [3] the largest increase in ruptures occurred to people over 40 years old.…”