Bilateral Simultaneous Achilles Tendon Rupture in the Absence of Risk Factors

Background: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of—and specific risk factors associated with—postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. Methods: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. Results: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. Conclusion: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. Level of Evidence: Level III, retrospective comparative series.

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Risk Factors for Failed Nonoperative Treatment and Rerupture in Acute Achilles Tendon Rupture

Foot & Ankle International ◽

10.1177/1071100717754042 ◽

2018 ◽

Vol 39 (6) ◽

pp. 694-703 ◽

Cited By ~ 7

Author(s):

Aleksi Reito ◽

Hanna-Liina Logren ◽

Katri Ahonen ◽

Heikki Nurmi ◽

Juha Paloneva

Keyword(s):

Risk Factors ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Case Series ◽

Nonoperative Treatment ◽

Activity Level ◽

Factors Associated ◽

Increased Risk ◽

Male Patients

Background: Nonoperative treatment is feasible in most patients with acute Achilles tendon rupture. Risk factors associated with failed nonoperative treatment are poorly understood. We investigated risk factors associated with rerupture after nonoperative treatment and otherwise failed nonoperative treatment of Achilles tendon rupture. Methods: All patients diagnosed with acute Achilles tendon rupture between January 2009 and June 2016 and who underwent 8 weeks of nonoperative treatment with functional rehabilitation were included in the study. Patients with rerupture or otherwise failed nonoperative treatment were identified retrospectively. Time to rerupture and association of age, sex, time from injury, diabetes, and visits to the physiotherapist for cases of reruptures and otherwise failed nonoperative treatment were investigated. A total of 210 patients were included in the study. Results: Fifteen patients sustained a rerupture. Rerupture incidence was 7.1%. Incidence of late reruptures, those occurring after return to daily activities at 12 weeks, was 1.9%. Six patients had otherwise failed nonoperative treatment. Median time to rerupture was 23 days (6 to 61) after the end of the treatment. The incidence of all-cause failure was 10.0%. Male gender was associated with reruptures ( P = .013) and failed nonoperative treatment for any reason ( P = .029). Conclusion: It is important to highlight the increased risk of rerupture in male patients during the first month after the end of the nonoperative treatment. Age alone, even in male patients, was a poor indication for operative treatment since it did not predict early failure. Further studies will hopefully clarify the influence of activity level on the risk of rerupture. Level of Evidence: Level IV, retrospective case series.

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Levofloxacin-Associated Achilles Tendon Rupture

Annals of Pharmacotherapy ◽

10.1345/aph.1c505 ◽

2003 ◽

Vol 37 (7-8) ◽

pp. 1014-1017 ◽

Cited By ~ 16

Author(s):

A Scott Mathis ◽

Vicky Chan ◽

Margaret Gryszkiewicz ◽

Robert T Adamson ◽

Gary S Friedman

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Acute Renal Failure ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Resonance Imaging ◽

Probability Scale ◽

Ankle Pain ◽

Case Summary

OBJECTIVE: To describe a case of levofloxacin-induced partial Achilles tendon rupture; this occurred in the presence of known risk factors and acute renal failure. CASE SUMMARY: A 79-year-old white man received levofloxacin for presumed pneumonia, developed acute renal failure in the setting of dehydration, and began having ankle pain on the 12th day of admission. Levofloxacin was discontinued, and magnetic resonance imaging revealed a 6-cm partial tear and degenerative changes. DISCUSSION: The Naranjo probability scale indicates a possible association between levofloxacin and tendon rupture because the event occurred in the setting of known risk factors such as steroid use, renal failure, older age, and male gender. CONCLUSIONS: Levofloxacin, like other fluoroquinolones, may cause Achilles tendon rupture, and this may be particularly likely with known risk factors.

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Are Patients Presenting with an Achilles Tendon Rupture at Greater Risk of Rupturing Their Contralateral Tendon? A Retrospective Cohort Study with Minimum 2 Years Follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00095 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Joaquin Palma ◽

Andres Villa ◽

Alejandro Freundlich ◽

Jose Dominguez Martinez ◽

Felipe Fuentealba Secul ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Achilles Tendon ◽

Median Time ◽

Odds Ratio ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

High Risk Population ◽

Injury Incidence

Category: Sports Introduction/Purpose: Study Design: Case-control Objective: To determine whether patients presenting with an Achilles tendon rupture are at greater risk of rupturing their contralateral tendon when compared to general population. Summary of Background Data: Extrinsic risk factors for Achilles tendon rupture, such as fluoroquinolones or local injections with corticosteroids, are well recognized. Genetic predisposition is another factor that has been proposed, since this pathology is more frequently seen in certain populations. Thus, it can be theorized that patients who have presented an Achilles tendon rupture are at higher risk of rupturing their contralateral tendon compared to general population. Previous reports by Arøen et al suggest than 10 out of 154 patients presented a contralateral injury (OR:176). Methods: Data from patients operated on from an acute Achilles tendon rupture were retrospectively retrieved from two academic centers. Patients were included if they had at least 2 years since their surgery and were willing to participate in the study. Each patient answered a telephone questionnaire regarding prior symptoms, contralateral rupture and risk factors (flouroquinolones, local corticosteroids and tobacco). Patients were excluded if they did not answer all questions or were unable to be contacted. Since data in our population is lacking, we used the overall incidence of Achilles tendon rupture published by Sheth et al. as the expected rate of Achilles tendon rupture in the general population. This value was compared to our cohort’s contralateral injury incidence to obtain an effect measure (odds ratio). Results: 246 consecutive Achilles tendon ruptures were treated during a 6-year follow-up period (2008-2016). 25 patients (8.5%) ruptured their contralateral tendon, equivalent to an incidence of 1407 ruptures per 100.000 inhabitants per year. Reported incidence of Achilles tendon rupture in the general population is 29 per 100.000 inhabitants per year. Odds ratio compared to the general population was 49.2 (95% CI: 34.1 – 73.7) (p <0.0001). Median time to contralateral rupture was 21.6 months (12 – 55) after the initial injury. There were no significant differences regarding age, sex, presence of external risk factors or prior symptoms in the group with a contralateral rupture. 81 patients (33%) experienced tendon pain of at least two weeks duration in relation to their initial rupture. Conclusion: Conclusion: Patients who sustain an Achilles tendon rupture are at higher risk (OR 49.2) of rupturing their contralateral tendon when compared to the general population. In our group, median time for the contralateral injury was 21.6 months. Discussion: Preventive strategies should be directed and conducted in this high risk population. Orthopedic surgeons should consider this information when counseling patients who sustained an Achilles tendon rupture.

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Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/0363546519876054 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3229-3237 ◽

Cited By ~ 3

Author(s):

Melissa Hornbæk Pedersen ◽

Liv Riisager Wahlsten ◽

Henrik Grønborg ◽

Gunnar Hilmar Gislason ◽

Michael Mørk Petersen ◽

...

Keyword(s):

Risk Factors ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Nonoperative Treatment ◽

Incidence Rates ◽

Factors Associated ◽

Increased Risk ◽

Male Sex

Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

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Factors Associated With Achilles Tendon Rupture in Women’s Collegiate Gymnastics

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211034510 ◽

2021 ◽

pp. 194173812110345

Author(s):

Joseph Bonanno ◽

Jennifer Cheng ◽

Dave Tilley ◽

Zafir Abutalib ◽

Ellen Casey

Keyword(s):

Risk Factors ◽

African American ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Black African ◽

Elite Level ◽

Tendon Ruptures ◽

Collegiate Gymnasts ◽

Female Gymnasts

Background: Achilles injury risk in women’s collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. Hypothesis: Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. Results: A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. Conclusion: Achilles tendon ruptures are more common in women’s collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. Clinical Relevance: Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.

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Analysis of Risk Factors for Deep Venous Thrombosis in Patients With Achilles Tendon Rupture: A Retrospective Study of 247 Patients

10.21203/rs.3.rs-404041/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Kai Liu ◽

Yanshi Liu ◽

Jiasharete Jielile ◽

Aihemaitijiang Yusufu

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Achilles Tendon ◽

Tendon Rupture ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Perioperative Period

Abstract Background and purpose The high incidence of deep venous thrombosis (DVT) was presented in patients with Achilles tendon rupture (ATR), and affects the prognosis of patients significantly. The purpose of this study was to identify and quantify the risk factors for perioperative DVT and the role of DVT in clinical outcomes, which may provide a guideline for DVT prevention and Achilles tendon repair. Methods The study was conducted on 247 patients who underwent surgical treatment for ATR at our institution from 2009 to 2019. Ultrasound results from injury to 4 weeks after operation were collected to diagnose DVT. Odds ratios (OR) were calculated using logistic regression to describe factors associated with DVT diagnosis including sex, age, body mass index (BMI), nicotine usage, mechanism of injury, rupture side, types of rupture, medical morbidity (hypertension, diabetes, coronary heart disease, stroke), time to operation, operative time and blood loss. The outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hind-Foot Scale Score at postoperative 3, 6, and 12 months. Results There were 216 males and 31 females with a mean age of 37.4 years (range from 20 to 75 years). Out of 247 patients, 113 patients were diagnosed with DVT during the perioperative period, accounting for 46 % of total patients. The independent risk factors were identified with age > 40 years (OR 0.41; 95% CI 0.21–0.82; p = 0.013), BMI > 26 (OR 0.39; 95% CI 0.19–0.79; p = 0.009), traumatic ATR (OR 2.44; 95% CI 1.22–4.91; p = 0.012), operative time (OR 0.95; 95% CI 0.91–1.01; p = 0.028), and blood loss (OR 1.09; 95% CI 1.03–1.14; p = 0.001). Worse patient-subjective and functional outcomes were presented in patients with a perioperative DVT according to ATRS and AOFAS. Conclusions Routine thromboprophylaxis should be encouraged in patients with ATR requiring surgery, which was caused by trauma. Age > 40 years and BMI > 26 were important risk factors for perioperative DVT. This study also showed that the presence of DVT of patients with ATR in the perioperative period has clear impairment of outcome within one year after surgery, which may postpone the return of athletes to the field severely.

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