Incidence Of Achilles Tendon Rupture Research Articles

Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study.

The aim of our study was to assess the regional variations in Achilles tendon rupture incidence and treatment methods in Finland during the period 1997-2019. The Finnish National Hospital Discharge Register (NHDR) and the Finnish Register of Primary Health Care Visits (PHCR) were searched to identify all adult patients diagnosed with Achilles tendon rupture during our study period. The population-based annual incidence and incidences of surgically and non-surgically treated Achilles tendon ruptures were calculated for each hospital district. Achilles tendon rupture incidence increased from 17.3 per 105person-years in 1997 to 32.3 per 105in 2019. The mean incidence of Achilles tendon ruptures ranged from 26.4 per 105(North Savo) to 37.2 per 105(Central Ostrobothnia). The incidence of Achilles tendon ruptures increased in all areas. The proportion of non-surgical treatment of Achilles tendon ruptures ranged in 1997 from 7% (Vaasa) to 67% (Åland) and in 2019 from 73% (Southwest Finland) to 100% (East Savo, Kainuu, Länsi-Pohja, Åland). During the study period, a shift towards non-surgical treatment was evident in all hospital districts. Regional variations in Achilles tendon rupture incidence exist in Finland; however, the incidence increased in all areas during the follow-up period. More Achilles tendon rupture patients are currently being treated non-surgically throughout the country.

Incidence, demographics, characteristics and management of acute Achilles tendon rupture: An epidemiological study.

Achilles tendon rupture (ATR) account for 10.7% of all tendon and ligament injuries and causes lasting muscular deficits and have a profound impact on patients' quality of life. The incidence, characteristics and management of ATR in the United Kingdom (UK) is poorly understood. This investigation aims to understand the incidence of ATR in the UK. Prospective data collection of ATR incidence from a United Kingdom Emergency department. Retrospective review of management protocols and immobilisation duration from electronic medical records. ATR incidence is 8 per 100,000 people per annum. Participants were predominately male (79.2%) and primarily reported a sporting mechanism of injury (65.2%). Mean immobilisation duration was 63.1 days. 97.1% were non-surgically managed post ATR. 46.2% of participants had experienced a previous ATR or Achilles tendinopathy prior to their current ATR. The incidence of ATR found was 8. cases per 100,000 people per annum. Most ATR were managed non-surgically in this cohort. The majority of ruptures occurred during sporting activity. Almost one quarter (23.3%) of individuals report Achilles pain prior to ATR.

Fabrication of atelocollagen-coated bioabsorbable suture and the evaluation of its regenerative efficacy in Achilles tendon healing using a rat experimental model

Recently, the incidence of Achilles tendon ruptures (ATRs) has become more common, and repair surgery using a bioabsorbable suture is generally preferred, particularly in the case of healthy patients. Sutures composed of poly(lactic-co-glycolic acid) (PLGA) are commonly used in ATR surgeries. Nevertheless, owing to the inherent limitations of PLGA, novel bioabsorbable sutures that can accelerate Achilles tendon healing are sought. Recently, several studies have demonstrated the beneficial effects of atelocollagen on tendon healing. In this study, poly(3,4-dihydroxy-L-phenylalanine) (pDOPA), a hydrophilic biomimetic material, was used to modify the hydrophobic surface of a PLGA suture (Vicryl, VC) for the stable coating of atelocollagen on its surface. The main objective was to fabricate an atelocollagen-coated VC suture and evaluate its performance in the healing of Achilles tendon using a rat model of open repair for ATR. Structural analyses of the surface-modified suture indicated that the collagen was successfully coated on the VC/pDOPA suture. Postoperative in vivo biomechanical analysis, histological evaluation, ultrastructural/morphological analyses, and western blotting confirmed that the tendons in the VC/pDOPA/Col group exhibit superior healing than those in the VC and VC/pDOPA groups after 1 and 6 weeks following the surgery. The this study suggests that atelocollagen-coated PLGA/pDOPA sutures are preferable for future medical applications, especially in the repair of ATR.

Stiffer gymnastics floors result in more dorsiflexed ankles, potentially increasing the risk for Achilles tendon ruptures

One in five female collegiate gymnasts suffers an Achilles tendon rupture (ATR), primarily on floor exercise. Training floors are used daily, sometimes for over 10 years, while floors at competition sites are often new. Consequently, training floors feel “soft” and competition floors feel “stiff”. We hypothesized that the ankle joint angle is in a more dorsiflexed position on a “stiff” compared to a “soft” floor during impact, resulting in greater tension of the Achilles tendon and, consequently, a higher incidence of ATRs during competition. Female gymnasts from 78 US collegiate teams were invited to complete a survey, assessing whether ATR occurred at the training or competition sites, among other items. The ankle joint angles during landing from back-tumbling-take-offs on “soft” and “stiff” gymnastics floors were determined using video imaging. Statistical analysis was performed by Pearson’s Chi Square test or t-tests, as appropriate. Twenty-one out of 103 gymnasts (20.4%, 95% CI: 13.6% to 29.4%) experienced an ATR. Relative to time, ATRs occurred only 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 hours on training floors, but 1.85±0.11 (95% CI: 1.60 to 2.10) times per 1000 hours (p<0.05) on competition floors. Ankle joint angles were in a more dorsiflexed position on the stiff (103.5±1.1 degree) than the soft floor (117.0±4.1 degree, p<0.05), implying greater tension on the Achilles tendon. We conclude that stiff floors favor more dorsiflexed ankle joints, increasing the tension on the Achilles tendon, and potentially explaining the higher relative incidence of ATRs at competition compared to training sites. This research was supported by the Offce of Research and Sponsored Programs at Burrell College of Osteopathic Medicine. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

DIAGNOSIS AND TREATMENT OF ACUTE ACHILLES TENDON RUPTURE: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Achilles tendon rupture is a common orthopaedic injury that results in substantial functional limitations throughout a lengthy recovery time. The increasing incidence of Achilles tendon ruptures has been well documented in population-based studies. The delayed treatment of AT ruptures is usually attributable to either poor diagnosis upon injury or patients disregarding their injuries and not presenting to healthcare facilities. The aim: The aim of this study to show about diagnosis and treatment of acute achilles tendon rupture. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 17 articles, whereas the results of our search on SagePub get 299 articles, on Google Scholar 6990 articles. Records remove before screening are 5317, so we get 1989 articles fos screening. After we screened based on record exclude, we compiled a total of 12 papers. We included five research that met the criteria. Conclusion: Multiple evaluative techniques including the addition of diagnostic ultrasound imaging and continuous shear wave elastography (cSWE) to standard clinical tests and measures were used to assess patient-reported symptoms, tendon structure, and tendon functional performance. As treatment recommendations and strategies evolve, decisional conflict may arise when patients with Achilles tendon ruptures are faced with the need to choose a management option. There have been several reviews of management strategies, primarily focused on pairwise comparisons between individual operative and non-operative strategies.

Higher risk of Achilles tendon ruptures at competition than training sites in female collegiate gymnasts.

Reportedly, 17.2% of collegiate female gymnasts experience Achilles tendon ruptures (ATRs). Cumulative microtraumas resulting in chronic tendinopathy/tendinitis may contribute to this high injury risk. We hypothesized that the risk of ATRs in female collegiate gymnasts increases with years of competitive gymnastics, that non-steroidal anti-inflammatory drug (NSAID) use is associated with less ATRs, and that the risk is larger during competition than training. Female gymnasts from 78 USA collegiate teams completed a survey assessing the prevalence of ATRs, NSAID use, age at which competitive gymnastics started and age at which ATR occurred, and whether ATRs occurred during training or competition. Twenty-one of 103 gymnasts (20.4%, 95% CI: 13.6% to 29.4%) experienced ATRs. Eighteen of 21 ruptures (85.7%, 95% CI: 61.3% to 95.8%) occurred after more than ten years of competitive gymnastics (mean: 14.0±2.6 years, 95% CI: 12.8 to 15.2 years). ATRs occurred 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 hours at training versus 1.85±0.11 (95% CI: 1.60 to 2.10) times per 1000 hours at competition (P<0.05). Prevalence of NSAID use was 27.6% (95% CI: 18.6% to 39.0%) in gymnasts without ATR but only 5.5% (95% CI: 0.6% to 35.5%, P=0.09) in gymnasts with ATR. Multiple regression analysis demonstrated a negative association between NSAID use and incidence of ATRs (P<0.05). Female collegiate gymnasts are at high risk for ATRs, especially after more than ten years of competitive gymnastics and during competition.

Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures.

We aimed to fill the research gap regarding the incidence of Achilles tendon rupture (ATR), which is reportedly increasing, as there is a lack of data on the incidence of ATR and no data on bilateral ruptures in our region. We determined the incidence of complete ATR among 273,485 people during 1991 to 2015. In the study period, 524 patients (486 [92.75%] men and 38 [7.25%] women, average age 39.03±10.86 [range 20-83] years, = sex ratio 12.8:1) were treated for ATR in our study area. The average incidence was 7.77 per 100,000 person-years, with an increasing trend until 2008 and peak incidence of 11.33 per 100,000 person-years. Most injuries (67.04%) occurred while performing sports activities. In total, 7 (1.34%) patients (six men [1.23%] and one woman [2.63%]) experienced ruptures on both sides, an average of 5.1 years apart; the average age at the second rupture was 57.71±16.69 (range 39-83) years, with a calculated incidence for bilateral ATR of 0.1 per 100,000 person-years. The incidence of complete ATR in our study region increased gradually between 1991 and 2008, after which it declined. Bilateral ATR during that period was a very rare injury.

Achilles Tendon Injury Treatment: the History and Current State of the Art

RELEVANCE The overall incidence of Achilles tendon rupture has been increasing in recent decades due to population aging, the growing prevalence of obesity and increased participation in sports. Achilles tendon ruptures are common injuries of the musculoskeletal system, and according to various authors, they account for 47% of all ruptures of human tendons and muscles, about 18 cases per 100 thousand people per year. Despite the abundance of various options of tendon suture in surgery, a wide choice of suture material and the use of precision techniques in tendon reconstruction, the proposed methods of macroscopic reconstruction of the tendon apparatus do not solve the problem of tendon suture failure.CONCLUSION Despite the abundance of proposed accesses to the Achilles tendon, the optimal one for all types of injuries has not yet been developed. Currently, there are no clear recommendations for choosing a specific method of treating an Achilles tendon rupture.

The influence of the COVID pandemic on the epidemiology of Achilles tendon ruptures in east Shropshire, United Kingdom

ObjectivesManagement strategies of the COVID pandemic included isolation to prevent transmission. This study aimed to determine if the pandemic of 2020 influenced the epidemiology of Achilles tendon rupture (ATR). MethodsThe demographics of presentations from the local population to Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust hospital, Shropshire, United Kingdom, with an ATR were analysed and compared together with the season, month, and year of the injury. ResultsFrom 2009 to 2019, there was no significant change in the incidence of ATR over time with a mean (SD) incidence of 13.3 per 100,000. In 2020, there was a decrease in injuries with an incidence of 8.4 per 100,000, with an increase in 2021 to 22.4 per 100,000. In 2021, there was an increase in injuries from March with numbers maintained until October.The most common activity of ATR was team sport (36.2%), followed by the activities of daily living (28.9%), other physical activities (21.0%), and racket sports (13.9%). In 2020, there was the lowest number of injuries sustained in team and racket sports; however, in 2021, they accounted for over half of injuries. ConclusionsThere were significantly more patients sustaining ATR in 2021, the year after the COVID pandemic and mandatory isolation. This was considered to be related to altered activity and team and racket sports during 2020. Levels of evidenceIV case series.

Incidence and Treatment Trends of Achilles Tendon Ruptures in Finland: A Nationwide Study.

Global reports indicate rising Achilles tendon rupture (ATR) incidence. In recent decades, the optimal treatment for this injury has been widely studied. Alongside the cumulating comparative evidence regarding the optimal method of treatment, nonoperative treatment has increased in popularity compared with operative treatment. To determine the current incidence of ATRs and their treatment in Finland and how these have changed from 1997 to 2019. Descriptive epidemiology study. Two national registers (the National Hospital Discharge Register and the Finnish Register of Primary Health Care Visits) were used to identify all ATR cases and operations to treat them; the incidence was calculated based on the annual adult population size. During the study period, ATR incidence increased from 17.3 to 32.3 per 100,000 person-years. The increase in incidence seemed to plateau starting in the second half of the study period. The rise in ATR incidence occurred in both sexes and all age groups but most markedly among the elderly. The incidence of operative treatment decreased from 13.6 to 4.9 per 100,000 person-years. This decline was observed from 2008 onward and in all age groups. The incidence of ATRs increased and the use of operative treatment decreased. The decreasing trend of operative treatment is in line with other international reports and resonates with the current literature about the optimal treatment of ATRs.

Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study

IntroductionThe incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders.AimsThe primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients.MethodsData were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men.ResultsA total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS.ConclusionTo our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.

A Comparison of Minimally Invasive Achilles Repair Techniques on Functional Outcome and Failure Rates

Category: Sports; Ankle Introduction/Purpose: The incidence of Achilles tendon ruptures (ATR) is 21.5 per 100,000 people, making it the most common tendon rupture of the lower extremity. Repair methods consist of the traditional open, indirect repair with suture anchors (Midsubstance SpeedBridge, MSB), or jig-assisted technique (Percutaneous Achilles Repair System, PARS) with MSB; the latter two being minimally invasive. Early mobilization is crucial for restoration of tendon strength and function. The available literature shows minimally invasive techniques allow early weight-bearing but lacks the direct comparison of the techniques on clinical recovery duration and patient outcomes. The purpose of the study was to compare safety (i.e., risk of re-rupture) and efficiency (i.e., days to medical clearance) between the traditional open, MSB, and PARS with MSB techniques for ATR repair. Methods: This retrospective study used the CPT code 27650 and yielded 103 patients that underwent a primary ATR between 2017 to 2021 that were managed by three fellowship-trained orthopedic surgeons. After excluding chronic tendinopathy, revisions, patients lost to follow up or non-compliance, 41 acutely injured patients remained. Patients were followed until medical clearance or they reached Maximal Medical Improvement (MMI). The chart review included complications (e.g., infection, healing issues, nerve issues, re-rupture), referral to physical therapy (PT), days non-weight bearing (NWB), physical exam findings, and patient compliance with recommendations. Continuous variables were examined using one-way ANOVAs, one-way ANCOVAs, Independent-Samples Median Tests, or Kruskall-Wallis H Tests for age, body mass index (BMI), recovery duration, days NWB, and days until PT referral. Chi-square tests or Fisher's Exact tests were performed to compare proportions for sex, and complications. Bonferroni adjustments were performed for post hoc testing. Results: 41 patients (39.7 +- 24 years old; 38 males; 7 females) and BMI of 30.3 +- 6.1 kg/m2 underwent an ATR repair. There were no significant differences between groups for re-rupture rates (none reported), complications (P = 0.245), age (P = 0.497), or BMI (P = 0.908). There were significant differences in recovery duration (P = 0.004) and days NWB (P = 0.001). After controlling for days NWB, recovery duration was significantly different between groups [F(2,41) = 6.098, P = 0.005; partial h2 = 0234]. Recovery duration for PARS (119.2 +- 44.0 days) was significantly quicker than both open (169.4 +- 41.6 days; P = 0.019) and MSB (167.2 +- 31.2 days; P = 0.009), but no differences between open and MSB (P = 1.00). Conclusion: The PARS with MSB method had a much shorter recovery duration with clearance occurring 50 days faster than other techniques. It is possible the PARS with MSB technique allowed for earlier mobilization which contributed to an accelerated recovery. Non-weight bearing days and early initiation of PT could be a factor in recovery duration and warrants further exploration. Future prospective research with a more homogenous patient population with a focus on early rehabilitation will provide greater insight.

Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture.

The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients. A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was defined using governmental population data and SEDS was defined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses. There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18years) was 18.75/100,000 per year (range 16.56-23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35-1.89; p < 0.001). When adjusting for confounding factors, least deprived patients were more likely to be > 50years old (OR 1.97; 95%CI 1.24-3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11-2.67; p = 0.02) and in the spring (OR 1.65, 95%CI 1.01-2.70; p = 0.045) and to give a history of preceding tendinitis (OR 4.04, 95%CI 1.49-10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23-0.87; p = 0.02) and to be obese (OR 0.25-0.41, 95%CI 0.07-0.90; p ≤ 0.03). The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Significant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries. Prognostic Study Level III.

523 Effect of the COVID-19 UK Lockdown on Lower Limb Tendon Ruptures

AimAchilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased.MethodA retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021.ResultsIn 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased.ConclusionsThis study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture and should prompt larger studies across multiple sites to confirm this.

Association between outdoor temperature and achilles tendon repair: A 14-years nationwide population-based cohort study

The incidence of achilles tendon rupture varies by gender, age, and seasonal variation. However, there has been no study as yet linking achilles tendon rupture to daily fluctuations in outdoor temperature. The purpose of this study was to investigate the association between outdoor temperature and achilles tendon rupture using a Korea Meteorological Administration database and a Korean National Health Insurance Service-National Sample Cohort database. Between 2002 and 2015, all instances of achilles tendon repair were retrieved from the National Health Insurance Service-National Sample Cohort database to examine sociodemographic factors, specifically sex, age, residential area, and income level. Minimum age requirement was 20 years. Outdoor temperatures recorded at 16 observation points in South Korea were also acquired from the Korea Meteorological Administration data center for analysis. Overall, 850 (0.119%) of 713,456 individuals in the National Health Insurance Service-National Sample Cohort database underwent achilles tendon repair between 2002 and 2015. Yearly procedural totals increased with advancing age, peaking at ages 30–39 years (14.6 per 100,000 persons) and declining thereafter. Minimum, median, and maximum outdoor temperatures were associated with achilles tendon repair (p<0.05), as did household income. In multivariate logistic regression analysis, outdoor temperatures, sex, age, and household income emerged as factors significantly associated with achilles tendon repair. Outcomes of this study confirm an association between incidence of achilles tendon repair and outdoor temperature, the latter denoting a novel index and likely surrogate measure of vigorous physical activity afforded by warmer weather.

Obesity is an Independent Risk Factor for Achilles Tendon Rupture: A Nationwide Longitudinal Cohort Study in South Korea

Category:Hindfoot; SportsIntroduction/Purpose:Obesity is an increasing comorbidity that can negatively affect the clinical outcomes of various disease in orthopaedics. However, there was no study to evaluate an association between Achilles tendon rupture and obesity in a nationwide study. We aimed to investigate the incidence of Achilles tendon rupture through a nationwide longitudinal cohort in Korea and evaluate the influences of demographic data including body mass index (BMI).Methods:Between 2002 and 2015, sociodemographic factors including gender, age, BMI, income, comorbidities, and sport activity level were retrieved from National Health Insurance Service-National Sample Cohort (NHIS-NSC). NHIS-NSC database was searched for individuals treated with ATR. We excluded individuals who were less than 20 years-old.Results:736 (0.116%) of total 636,921 individuals in NHIS-NSC database underwent Achilles tendon repair (ATR). Multivariable logistic regression analysis revealed that obesity (BMI>= 25kg/m2) was significantly associated with ATR (odds ratio, 1.99; 95% confidence interval, 1.68 to 2.36). Other significant factors were age, male, total cholesterol, moderate sport activity, and income. After propensity score matching of all factors, obesity was significantly associated with ATR with odds ratio 1.95 (95% confidence interval, 1.60 to 2.39).Conclusion:Obesity is an independent predictive factor for the occurrence of Achilles tendon rupture followed by ATR.

Non-Operative Management of Chronic Achilles Tendon Ruptures: Short Term Outcomes

Category:Hindfoot; Sports; TraumaIntroduction/Purpose:The incidence of Achilles tendon rupture in the United States is approximately 2.6 per 100,000 person years, with a significant increase in incidence over recent years reported. Should the acute rupture not be diagnosed promptly, as is the case in up to 20% of patients, the injury may be termed chronic. A number of operative treatment strategies for chronic Achilles ruptures have been described, including v-y tendinous flap, flexor hallucis longus tendon transfer, peroneus brevis graft and free gracilis transfer. Despite the extensive investigation of non-operative treatment in acute ruptures, there is a lack of similar research into chronic injuries. This article aims to address this gap in the literature, reporting treatment results of patients treated conservatively after being deemed unfit for operative intervention.Methods:A retrospective review of all patients receiving non-operative treatment for chronic Achilles ruptures, in the senior author's clinic between December 2014 and May 2019 was performed. A chronic injury was defined as occurring when there was a delay of at least 28 days between initial injury and start of treatment. Patients with a minimum final follow up of less than 6 months were excluded. All patients were managed according to the previously described Leicester Achilles Management Protocol (LAMP), an eight-week functional dynamic regime with use of a VACOped boot (OPED, Valley, Germany). Formal physiotherapy treatment was also provided following completion of the LAMP. Hospital records were searched for relevant data including patient age and sex, side of injury, time between injury and start of treatment and post-treatment Achilles tendon total rupture score (ATRS).Results:A total of 17 consecutive patients with a minimum follow up of 6 months were managed non-operatively during the stated time period. The cohort included eight males and nine females with a mean age of 63.4 14.3 years. The right side was injured in five cases, with the left side affected in 12. The mean time from initial injury to start of treatment was 43.9 days (range 30 - 102 days). The mean ATRS at 6 months post treatment was 53+-17.8. A total of 10 patients were also available for follow up at 12 months. The mean ATRS in these patients at 12 months was 73 +-15.2.Conclusion:The mean 12-month ATRS of 73 achieved is lower than figures of 89-92.5 reported in previous studies describing operative treatment. However, our results indicate that good outcomes may be achieved using a non-operative protocol in patients who decline or are unfit for surgery. Recent research reports that the mean age of Achilles rupture has increased by 0.721 years every five years, since 1953. It could therefore be likely that an increasing number of patients suffering chronic Achilles ruptures may be unfit for surgical treatment. It is important that further research into the non-operative treatment of these patients is conducted.

Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair

The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely. This study aimed to introduce our most accelerated functional rehabilitation protocol following surgery for acute Achilles tendon rupture and to review the results retrospectively. From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated. The mean time to be able to squat fully was 10 ± 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients). The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 ± 3.9 (6-24) and 23.3 ± 7.7 (8-40) weeks, respectively. The mean time to return to sports was 20.6 ± 5.2 (12-32) weeks. The major complication rate was 3.5% (one re-rupture and one tendon elongation). The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 ± 3.7 (20-38) and 79.3 ± 18.5 (20-98) points, respectively. The increase was significant (p < .01). In conclusion, immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results.

Increase in Achilles Tendon Rupture Surgery in Japan: Results From a Nationwide Health Care Database.

Background:Nationwide epidemiologic studies in Scandinavian countries have shown that the incidence of Achilles tendon ruptures (ATRs) has increased, and the rate of surgical treatment has declined markedly in the past decade. However, there is a lack of national-level data on the trend of ATRs and surgical procedures in other regions.Purpose:To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan.Study Design:Descriptive epidemiology study.Methods:Age- and sex-stratified data on the annual number of ATRs and surgical procedures between 2010 and 2017 were obtained from the Japanese national health care database, which includes almost all inpatient and outpatient medical claims nationwide. The Japanese population data were also obtained from the population census. The change in the annual incidence of ATRs per 100,000 people was assessed using a Poisson regression analysis. The trend in the annual proportion of surgeries relative to the occurrence of tendon ruptures was determined using a linear regression analysis.Results:A total of 112,601 ATRs, with men accounting for 67%, were identified over 8 years. Patients aged ≥60 years accounted for 27,106 (24%), while those aged 20 to 39 years and 40 to 59 years accounted for 36,164 (32%) and 49,331 (44%), respectively. The annual incidence of ATR ranged from 12.8/100,000 to 13.9/100,000 (women, 8.2-8.9/100,000; men, 17.2-19.5/100,000), which did not change over the study period (P = .82). Moreover, the annual incidences did not change across sexes and age categories. The annual proportion of surgery increased significantly, from 67% in 2010 to 72% in 2017 (P = .003). The annual proportions increased across sexes and age categories except for women aged 40 to 59 years.Conclusion:The incidence of ATR did not change between 2010 and 2017, according to the Japanese nationwide health care database. Furthermore, the proportion of surgical treatment increased during the study period. Overall, 70% of patients underwent surgical treatment. This study suggested that the trend in ATR and surgery differed across regions.

The effect of fear of reinjury on joint power distribution during a drop countermovement jump two years after an Achilles tendon rupture

The incidence of Achilles tendon rupture (ATR) is increasing and at least 20% do not return to preinjury activity. The aim of the study was to evaluate biomechanical differences between those assigned to a Fear group and No-Fear group based on fear of reinjury during activity after ATR, by evaluating a drop countermovement jump. Twenty-five participants were evaluated 23.5 months after ATR. Peak values for eccentric and concentric joint power were identified for ankles, knees, and hips. Participants were assigned to Fear group or No-Fear group depending on their answers to a question regarding fear of reinjury during activities. Interlimb peak power was compared between groups for landing and push-off with a mixed model ANOVA. Compared to the No-fear group, the Fear group presented significant decreased power in the ankle (P < .001) but increased power in the knee (P < .001) in involved limb during both phases. A 3-way interaction was found between group, side, and phase for frontal plane hip power (P < .001). Our findings indicate that those who are afraid of reinjury demonstrate higher interlimb differences compared to those who are not. They also compensate for ankle deficits with greater knee and hip power.