Testosterone replacement therapy is associated with increased odds of Achilles tendon injury and subsequent surgery: a matched retrospective analysis

Abstract

Background Prescription of testosterone replacement therapy (TRT) has increased in the United States in recent years, and though anabolic steroids have been associated with tendon rupture, there is a paucity of literature evaluating the risk of Achilles tendon injury with TRT. This study aims to evaluate the associative relationship between consistent TRT, Achilles tendon injury, and subsequent surgery. Methods This is a one-to-one matched retrospective cohort study utilizing the PearlDiver database. Records were queried for patients aged 35–75 who were prescribed at least 3 consecutive months of TRT between January 1, 2010 and December 31, 2019. Achilles tendon injuries and subsequent surgeries were identified using ICD-9, ICD-10, and CPT billing codes. Multivariable logistic regression was used to compare odds of Achilles tendon injury, Achilles tendon surgery, and revision surgery, with a p-value < 0.05 representing statistical significance. Results A sample of 423,278 patients who filled a TRT prescription for a minimum of 3 consecutive months was analyzed. The 2-year incidence of Achilles tendon injury was 377.8 (95% CI, 364.8–391.0) per 100,000 person-years in the TRT cohort, compared to 245.8 (95% CI, 235.4–256.6) in the control (p < 0.001). The adjusted analysis demonstrated TRT to be associated with a significantly increased likelihood of being diagnosed with Achilles tendon injury (aOR = 1.24, 95% CI, 1.15–1.33, p < 0.001). Of those diagnosed with Achilles tendon injury, 287/3,198 (9.0%) of the TRT cohort subsequently underwent surgery for their injury, compared to 134/2,081 (6.4%) in the control cohort (aOR = 1.54, 95% CI, 1.19–1.99, p < 0.001). Conclusions There is a significant association between Achilles tendon injury and prescription TRT, with a concomitantly increased rate of undergoing surgical management. These results provide insight into the risk profile of TRT and further research into the science of tendon pathology in the setting of TRT is an area of continued interest.

Testosterone

“…For the quadriceps tendon, the TRT patients had an increased rate of tearing that was 5.8 times higher than the non-TRT control group. There was a 4.7 times higher rate of tears requiring repair 42 . The distal biceps study demonstrated that the TRT patients had a 4.1 times higher tear rate than the matched control group in the first year after starting TRT.…”

“…Additionally in similar studies, the same group also showed increases in tendon ruptures and the need for surgical treatment of these injuries in other areas of the body [41][42][43] . For the quadriceps tendon, the TRT patients had an increased rate of tearing that was 5.8 times higher than the non-TRT control group.…”

“…The final study showed a 1.24 times increased risk of having an Achilles tear in the TRT group. A 1.54 times increased risk of undergoing operative repair was noted 42 .…”