1
|
Svedman S, Marcano A, Ackermann PW, Felländer-Tsai L, Berg HE. Acute Achilles tendon ruptures between 2002-2021: sustained increased incidence, surgical decline and prolonged delay to surgery-a nationwide study of 53 688 ruptures in Sweden. BMJ Open Sport Exerc Med 2024; 10:e001960. [PMID: 39040046 PMCID: PMC11261689 DOI: 10.1136/bmjsem-2024-001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Given the lack of consensus on optimal treatment strategies for acute Achilles tendon rupture (ATR), understanding temporal trends, treatment choice and demographic characteristics is important. Previous research suggests increasing incidence with declining surgical treatment. Current trends in Sweden are not known. Hypothesis/purpose To assess how incidence rates, treatment trends and time from injury to surgery (TTS) of ATR have changed between 2002 and 2021 in Sweden, with particular attention to changes since 2012. Study design Descriptive epidemiology study. Methods We conducted a nationwide register-based study including all inpatients and outpatients ≥18 years of age with an ATR between 2002 and 2021 in Sweden. Results 53 688 ATRs (78.5% men) were identified during the study period. 15 045 patients (81.5% men) were surgically treated within 30 days. The long-term incidence rate for ATR injury increased by 45%, from 28.8 in 2002 to 41.7 in 2021 per 100 000 person-years (p<0.0001). In the last 5 years of the study, there was a significant, continuing increase in ATR incidence by 21%, from 34.4 in 2017 to 41.7 in 2021 per 100 000 person-years (p<0.0001). The surgical incidence rates decreased from 13.4 to 6.0 per 100 000 person-years (p<0.0001). TTS increased from 0.6 days in 2002 to 5.1 in 2021 (p<0.0001). Conclusion The observed increase in incidence rates and decrease in surgical treatment of ATR emphasise the need for evidence-based treatment and rehabilitation protocols for non-operated patients of all ages. A significant increase in time from injury to surgery was observed throughout the study period.
Collapse
Affiliation(s)
- Simon Svedman
- Department of Orthopedics, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alejandro Marcano
- Department of Orthopedics, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Ackermann
- Department of Orthopedics, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Hans Erik Berg
- Department of Orthopedics, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Brodeur PG, Salameh M, Boulos A, Blankenhorn BD, Hsu RY. Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241266190. [PMID: 39091402 PMCID: PMC11292698 DOI: 10.1177/24730114241266190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. Methods The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. Results The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. Conclusion This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level of Evidence Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Peter G. Brodeur
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alexandre Boulos
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brad D. Blankenhorn
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raymond Y. Hsu
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
3
|
Abstract
The Achilles tendon has a high incidence of ruptures often occurring in weekend warriors and the aging population. Based on anatomic studies of the Achilles tendon, ruptures are commonly found in the watershed area proximal to the insertion site. Traditionally, treatment options included conservative therapy with immobilization and a prolonged non-weight-bearing phase versus surgical treatment. Surgical treatment can vary between open, minimally invasive, or percutaneous approaches. In more recent years, early functional rehabilitation with or without surgery has shown to have successful results.
Collapse
Affiliation(s)
- Varsha Salunkhe Ivanova
- Kaiser Permanente Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA.
| | - Khanh Phuong Sieu Tong
- Kaiser Permanente Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA
| | - Cristian Neagu
- Kaiser Permanente Santa Clara Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA
| | - Christy M King
- Kaiser Permanente, Department of Foot & Ankle Surgery, 3600 Broadway, Clinic 17, Oakland, CA 94611, USA; Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Oakland, CA, USA
| |
Collapse
|
4
|
Uchino S, Taguri M. Epidemiology of cruciate ligament surgery in Japan: A repeated cross-sectional study from 2014 to 2021. PLoS One 2023; 18:e0288854. [PMID: 38134038 PMCID: PMC10745212 DOI: 10.1371/journal.pone.0288854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Understanding the incidence and trends of cruciate ligament (CL) surgeries in Japan is crucial for providing effective healthcare services. This study aimed to use open data available from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) to analyze changes in CL surgeries over time and the characteristics of the Japanese population by sex and age. We retrospectively identified CL surgeries of the knee joint registered from April 2014 to March 2022 using the NDB open data. Data on sex, age, and practice were extracted to determine the number of cases per 100,000 population. Trends in the annual incidence of CL surgeries were evaluated using Poisson regression analysis. A total of 142,931 CL surgeries were performed from 2014 to 2021, with arthroscopic ligament reconstruction accounting for 98% of cases. The number of surgeries significantly increased from 16,975 in 2014 to 19,735 in 2019 (P<0.001). CL surgeries were most common in the 15-19 and 20-29 years age groups, with variations between males and females. The incidence of CL surgery in Japan has increased, with characteristics varying by sex and age, including middle-aged and older patients. Further investigation of general patterns in CL surgery in Japan would be valuable.
Collapse
Affiliation(s)
- Shota Uchino
- Department of Data Science, Graduate School of Data Science, Yokohama City University, Kanazawa-ku, Yokohama, Japan
- REHASAKU Co., Ltd., Minato-ku, Tokyo, Japan
| | - Masataka Taguri
- Department of Health Data Science, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
5
|
Yoshida K, Itoigawa Y, Morikawa D, Maruyama Y, Ishijima M. Chronologic Changes in the Elastic Modulus of a Healing Achilles Tendon Rupture Measured Using Shear Wave Elastography. Foot Ankle Int 2023; 44:243-250. [PMID: 36788728 DOI: 10.1177/10711007221151083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Shear wave elastography (SWE) has been used to examine the elasticity of a ruptured Achilles tendon; however, the healing process of a ruptured tendon has not been studied yet. This study aimed to detail the change in mechanical properties of a healing Achilles tendon rupture managed conservatively or surgically using SWE. METHODS Using a prospective cohort study design, we evaluated the patients treated conservatively (conservative group) and surgically (surgical group) with the "gift-box" technique for an isolated index acute Achilles tendon rupture during their healing process. SWE measurements were taken of both the injured and uninjured sides every 4 weeks up to 24, 36, and 48 weeks after treatment. Additionally, tendon thickness and power Doppler (PD) grade were measured at the same time points as SWE measurements. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot rating system score and Achilles tendon Total Rupture Score (ATRS) were compared at 24 and 48 weeks. RESULTS The ruptured Achilles tendon obtained an SWE value comparable with the unruptured side at 12 weeks in the conservative group and at 4 weeks with surgical group. The surgical group had significantly higher SWE values up to 24 weeks compared with the conservative group. Additionally, this group had a significantly larger increase in tendon thickness in nearly all periods. Both treatment groups were comparable regarding the PD grade, AOFAS score, and ATRS. CONCLUSION SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. LEVEL OF EVIDENCE Level II, prospective cohort study.
Collapse
Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Carmont MR, Morgan F, Fakoya K, Heaver C, Brorsson A, Nilsson-Helander K. The influence of the COVID pandemic on the epidemiology of Achilles tendon ruptures in east Shropshire, United Kingdom. J ISAKOS 2022; 8:94-100. [PMID: 36375752 DOI: 10.1016/j.jisako.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Management 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). METHODS The 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. RESULTS From 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. CONCLUSIONS There 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 EVIDENCE IV case series.
Collapse
Affiliation(s)
- Michael R Carmont
- The Department of Trauma & Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, TF1 6TF, United Kingdom; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 41390, Sweden.
| | - Fraser Morgan
- The Department of Trauma & Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, TF1 6TF, United Kingdom
| | - Keji Fakoya
- The Department of Trauma & Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, TF1 6TF, United Kingdom
| | - Catriona Heaver
- The Robert Jones & Agnes Hunt Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom
| | - Annelie Brorsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 41390, Sweden
| | - Katarina Nilsson-Helander
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 41390, Sweden
| |
Collapse
|
7
|
Leino O, Keskinen H, Laaksonen I, Mäkelä K, Löyttyniemi E, Ekman E. Incidence and Treatment Trends of Achilles Tendon Ruptures in Finland: A Nationwide Study. Orthop J Sports Med 2022; 10:23259671221131536. [PMID: 36389616 DOI: 10.1177/23259671221131536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: 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. Purpose: To determine the current incidence of ATRs and their treatment in Finland and how these have changed from 1997 to 2019. Study Design: Descriptive epidemiology study. Methods: 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. Results: 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. Conclusion: 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.
Collapse
Affiliation(s)
- Oskari Leino
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Heli Keskinen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Elina Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
8
|
Kastoft R, Barfod K, Bencke J, Speedtsberg MB, Hansen SB, Penny JØ. 1.7 cm elongated Achilles tendon did not alter walking gait kinematics 4.5 years after non-surgical treatment. Knee Surg Sports Traumatol Arthrosc 2022; 30:3579-3587. [PMID: 35234975 DOI: 10.1007/s00167-022-06874-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of the present study was to evaluate Achilles tendon length after non-surgical treatment of acute Achilles tendon rupture (aATR), and to evaluate indirect effects of possible persistent elongation on kinematics. METHODS The study was performed as a cross-sectional study based on a population of patients from an RCT regarding non-operative treatment of aATR. Thirty-seven patients out of the 56 in the original RCT participated with at a follow up of 4-5 years after aATR. Primary outcome was Achilles tendon elongation. Additional outcomes were Achilles tendon resting angle (ATRA), calf circumference, passive ankle plantar and dorsiflexion and loading pattern. Foot pressure mapping was performed to measure plantar loading distribution pattern; medial and lateral forefoot peak pressure, heel peak pressure, medial versus lateral loading pattern and timing of heel lift during roll over process. The healthy leg was used as a control. RESULTS The injured Achilles tendon was significantly elongated by 1.7 (SD 1.6) cm compared to the non-injured leg. A slight delay of 2.6% (SD 6.0) was measured in heel lift in the injured side compared to the non-injured leg. We found no significant difference in forefoot peak pressure, medial and lateral peak pressure as well as heel peak pressure, and no correlation was found between Achilles tendon length and pressure measurements. Finally, dorsiflexion was 1.9°(SD1.28) larger, ATRA 8.1°(SD6.7) larger, and calf circumference 1.6 cm (SD1.1) lower on the injured leg. CONCLUSION The Achilles tendon was 1.7 cm elongated 4.5 years after the initial injury and significant changes in ATRA, calf circumference and passive dorsiflexion was present. Except for a slight delay in heel lift-off, kinematics during walking was symmetrical between injured and healthy leg, even with an elongated tendon on the injured leg. The clinical relevance of the Achilles tendon elongation is uncertain. LEVEL OF EVIDENCE II. CLINICAL TRIALS IDENTIFIER NCT02760784.
Collapse
Affiliation(s)
- Rasmus Kastoft
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Kristoffer Barfod
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jesper Bencke
- Laboratory of Human Movement Analysis, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager, Hvidovre, Denmark
| | - Merete B Speedtsberg
- Laboratory of Human Movement Analysis, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager, Hvidovre, Denmark
| | - Sanja Bay Hansen
- Department of Radiology, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jeannette Ø Penny
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark
| |
Collapse
|