Achilles Tendon Injuries in a United States Population
Male athletes are the group most likely to tear their Achilles tendon, according to this study. The activity most likely to cause the injury was basketball, and NBA players such as Kobe Bryant have been in the news lately for this exact injury. The authors of this article reviewed 406 records from patients at one clinic diagnosed with Achilles tendon injuries from August 2000 and December 2010. The average age was 46 years old, 83% of the patients were males, and sports were responsible for 68% of the ruptures. “Delayed diagnosis and treatment have been shown to result in poorer outcomes,” says Steven Raikin, MD, of the Rothman Institute in Philadelphia, PA, and American Orthopaedic Foot & Ankle Society (AOFAS) member. “Older individuals, and those with a higher BMI, should be evaluated carefully if they have lower leg pain or swelling in the Achilles tendon region.” The study supported previous findings that an Achilles tendon rupture on one leg increases the likelihood of a rupture on the other leg.
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Background: Most studies on Achilles tendon ruptures involved US military or European populations, which may not translate to the general US population. The current study reviews 406 consecutive Achilles tendon ruptures occurring in the general US population for patterns in a tertiary care subspecialty referral setting.
Methods: An institutional review board–approved, retrospective review of the charts of 331 (83%) males (6 bilateral, nonsimultaneous) and 69 (17%) females diagnosed with Achilles tendon ruptures over a 10-year period was undertaken. Average age was 46.4 years with 310 (76%) ruptures diagnosed and managed acutely (less than 4 weeks), whereas 96 (24%) were chronic (more than 4 weeks since the injury). Patients were assessed for mechanism of injury and previously described underlying risk factors. Results were assessed according to age (greater or less than 55 years), body mass index (BMI), and time to diagnosis.
Results: Sporting activity was responsible for 275 ruptures (68%). This was higher in patients younger than 55 years of age (77%) than those older than 55 years (42%). Basketball was the most commonly involved sport, accounting for 132 ruptures (48% of sports ruptures, 32% of all ruptures), followed by tennis in 52 ruptures (13%, 9%), and football in 32 ruptures (12%, 8%). In all, 20 ruptures were reruptures of the same Achilles tendon, of which 17 had previously been treated nonsurgically. In this study, recent quinolone use (2%) and African American race (31%) were not major risk factors for rupture as described in other studies. Older patients and patients with a BMI greater than 30 were more likely to be injured in nonsporting activities and more likely to have their diagnosis initially not recognized resulting in their presentation more than 4 weeks following the injury.
Conclusion: In this study, sports participation was the most common mechanism, but not to the same extent seen in the European or US military studies. Basketball was the most commonly involved sport, as compared to soccer in Europe. Age and BMI had a directly proportional correlation with time to diagnosis.
Level of Evidence: Level II, epidemiologic study.
Raikin, S., Garras, D., & Krapchev, P. (2013). Achilles Tendon Injuries in a United States Population Foot & Ankle International, 34 (4), 475-480 DOI: 10.1177/1071100713477621