Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2016

01-12-2016 | Ankle

Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients

Authors: Ann Ganestam, Thomas Kallemose, Anders Troelsen, Kristoffer Weisskirchner Barfod

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2016

Login to get access

Abstract

Purpose

The purpose of this study is to investigate the incidence of acute Achilles tendon rupture in Denmark from 1994 to 2013 with focus on sex, age, geographical areas, seasonal variation and choice of treatment.

Methods

The National Patient Registry was retrospectively searched to find the number of acute Achilles tendon rupture in Denmark during the time period of 1994–2013. Regional population data were retrieved from the services of Statistics Denmark.

Results

During the 20-year period, 33,160 ruptures occurred revealing a statistically significant increase in the incidence (p < 0.001, range = 26.95–31.17/100,000/year). Male-to-female ratio was 3:1 and average age 45 years for men and 44 years for women. There was a statistically significant increasing incidence for people over 50 years. A higher incidence in rural compared with urban geographical areas was found, but this was not statistically significant. There was a statistically significant decreasing incidence of patients treated with surgery from 16.9/105 in 1994 to 6.3/105 in 2013.

Conclusions

The incidence of acute Achilles tendon rupture increased from 1994 to 2013 based on increasing incidence in the older population. There was no difference in incidence of acute Achilles tendon rupture in the rural compared with urban geographical areas. A steady decline in surgical treatment was found over the whole period, with a noticeable decline from 2009 to 2013, possibly reflecting a rapid change in clinical practice following a range of high-quality randomized clinical trials (RCT).

Level of evidence

IV.
Literature
1.
go back to reference Barfod KW, Nielsen F, Helander KN, Mattila VM, Tingby O, Boesen A, Troelsen A (2013) Treatment of acute Achilles tendon rupture in Scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments. J Foot Ankle Surg 52(5):629–633CrossRefPubMed Barfod KW, Nielsen F, Helander KN, Mattila VM, Tingby O, Boesen A, Troelsen A (2013) Treatment of acute Achilles tendon rupture in Scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments. J Foot Ankle Surg 52(5):629–633CrossRefPubMed
2.
go back to reference Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U (1993) Operative versus nonoperative treatment of Achilles tendon rupture a prospective randomized study and review of the literature. Am J Sports Med 21:791–799CrossRefPubMed Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U (1993) Operative versus nonoperative treatment of Achilles tendon rupture a prospective randomized study and review of the literature. Am J Sports Med 21:791–799CrossRefPubMed
5.
go back to reference Houshian S, Tscherning T, Riegels-Nielsen P (1998) The epidemiology of Achilles tendon rupture in a Danish county. Injury 29:651–654CrossRefPubMed Houshian S, Tscherning T, Riegels-Nielsen P (1998) The epidemiology of Achilles tendon rupture in a Danish county. Injury 29:651–654CrossRefPubMed
6.
go back to reference Huttunen TT, Kannus P, Rolf C, Felländer-Tsai L, Mattila VM (2014) Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med 42:2419–2423CrossRefPubMed Huttunen TT, Kannus P, Rolf C, Felländer-Tsai L, Mattila VM (2014) Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med 42:2419–2423CrossRefPubMed
7.
go back to reference Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 36:765–773CrossRefPubMed Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 36:765–773CrossRefPubMed
8.
go back to reference Keating JF, Will EM (2011) Operative versus non-operative treatment of acute rupture of tendo Achilles: a prospective randomised evaluation of functional outcome. J Bone Joint Surg Br 93:1071–1078CrossRefPubMed Keating JF, Will EM (2011) Operative versus non-operative treatment of acute rupture of tendo Achilles: a prospective randomised evaluation of functional outcome. J Bone Joint Surg Br 93:1071–1078CrossRefPubMed
9.
go back to reference Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ (2002) Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med 30:783–790PubMed Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ (2002) Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med 30:783–790PubMed
10.
go back to reference LanttoI Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J (2014) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci. doi:10.1111/sms.12253 LanttoI Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J (2014) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci. doi:10.​1111/​sms.​12253
11.
go back to reference Leppilahti J, Puranen J, Orava S (1996) Incidence of Achilles tendon rupture. Acta Orthop 67:277–279CrossRef Leppilahti J, Puranen J, Orava S (1996) Incidence of Achilles tendon rupture. Acta Orthop 67:277–279CrossRef
12.
13.
go back to reference Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R (2003) Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med 31:692–700PubMed Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R (2003) Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med 31:692–700PubMed
14.
go back to reference Mattila VM, Huttunen TT, Haapasalo H, Sillanpää P, Malmivaara A, Pihlajamäki H (2013) Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med. doi:10.1136/bjsports-2013-092756 PubMed Mattila VM, Huttunen TT, Haapasalo H, Sillanpää P, Malmivaara A, Pihlajamäki H (2013) Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med. doi:10.​1136/​bjsports-2013-092756 PubMed
15.
go back to reference Moller A, Westlin NE (1996) Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 67:479–481CrossRefPubMed Moller A, Westlin NE (1996) Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 67:479–481CrossRefPubMed
16.
go back to reference Nillius AS, Nilsson BE, Westlin NE (1976) The incidence of Achilles tendon. Acta Orthop Scand 47:118–121CrossRefPubMed Nillius AS, Nilsson BE, Westlin NE (1976) The incidence of Achilles tendon. Acta Orthop Scand 47:118–121CrossRefPubMed
17.
go back to reference Nilsson Helander K, Olsson N, Eriksson BI, Karlsson J (2014) Individualiserad behandling viktig vid akut hälseneruptur. Lakartidningen 111:CXWT Nilsson Helander K, Olsson N, Eriksson BI, Karlsson J (2014) Individualiserad behandling viktig vid akut hälseneruptur. Lakartidningen 111:CXWT
18.
go back to reference Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J (2010) Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38:2186–2193CrossRefPubMed Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J (2010) Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38:2186–2193CrossRefPubMed
19.
go back to reference Nyyssönen T, Lüthje P, Kröger H (2008) The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg 97:272–275PubMed Nyyssönen T, Lüthje P, Kröger H (2008) The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg 97:272–275PubMed
20.
go back to reference Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J (2013) Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med 41:2867–2876CrossRefPubMed Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J (2013) Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med 41:2867–2876CrossRefPubMed
21.
go back to reference Raikin SM, Garras DN, Krapchev PV (2013) Achilles tendon injuries in a United States population. Foot Ankle Int 34:475–480CrossRefPubMed Raikin SM, Garras DN, Krapchev PV (2013) Achilles tendon injuries in a United States population. Foot Ankle Int 34:475–480CrossRefPubMed
23.
go back to reference Suchak AA, Bostick G, Reid D, Blitz S, Jomha N (2005) The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int 26:932–936PubMed Suchak AA, Bostick G, Reid D, Blitz S, Jomha N (2005) The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int 26:932–936PubMed
24.
go back to reference Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important?: a randomized prospective study. Am J Sports Med 35:2033–2038CrossRefPubMed Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important?: a randomized prospective study. Am J Sports Med 35:2033–2038CrossRefPubMed
25.
go back to reference Vosseller JT, Ellis SJ, Levine DS, Kennedy JG, Elliott AJ, Deland JT, Roberts MM, O’Malley MJ (2013) Achilles tendon rupture in women. Foot Ankle Int 34:49–53PubMed Vosseller JT, Ellis SJ, Levine DS, Kennedy JG, Elliott AJ, Deland JT, Roberts MM, O’Malley MJ (2013) Achilles tendon rupture in women. Foot Ankle Int 34:49–53PubMed
26.
go back to reference Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92:2767–2775CrossRefPubMed Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92:2767–2775CrossRefPubMed
Metadata
Title
Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients
Authors
Ann Ganestam
Thomas Kallemose
Anders Troelsen
Kristoffer Weisskirchner Barfod
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3544-5

Other articles of this Issue 12/2016

Knee Surgery, Sports Traumatology, Arthroscopy 12/2016 Go to the issue