Predictors of Primary Achilles Tendon Ruptures
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SYSTEMATIC REVIEW
Predictors of Primary Achilles Tendon Ruptures Femke M. A. P. Claessen • Robert-Jan de Vos Max Reijman • Duncan E. Meuffels
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Springer International Publishing Switzerland 2014
Abstract Background The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing. Objectives The aim of this review was to systematically summarize predictors influencing Achilles tendon rupture (ATR) risk. Methods A systematic literature search was performed of reported determinants influencing the ATR risk. Studies were eligible if there was: (i) description of determinants predicting ATR; (ii) an outcome defined as ATR; (iii) any study design with at least ten adults included with ATR; (iv) use of statistical tests regarding differences between patients with an ATR and healthy controls; (v) a full text article available; (vi) an article written in English, German or Dutch. Quality assessment was done using a standardized criteria set. Best-evidence synthesis was performed. Results We included 31 studies, of which two (6.5 %) were considered high-quality studies. Moderate evidence was found for increased ATR risk and decreased fibril size of Achilles tendon. Conclusion Based on the results of this systematic review there is moderate evidence that decreased tendon fibril size increases the ATR risk. There is limited evidence for many other factors, some of which are modifiable, such as
F. M. A. P. Claessen R.-J. de Vos M. Reijman D. E. Meuffels (&) Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands e-mail: [email protected] R.-J. de Vos Department of Sports Medicine, The Hague Medical Centre, Leidschendam, The Netherlands
increased body weight, oral corticosteroid use and quinolone use and living in an urban area, and therefore may be of interest in future studies. Furthermore, these results showed that more high-quality studies are needed for evaluating the determinants influencing the ATR risk.
1 Introduction The prevalence of Achilles tendon rupture is 6–37/100,000 person years [1–6] and the incidence appears to be increasing [3, 7]. Most Achilles tendon ruptures are associated with sport activities [8–10]. A rising incidence could be partly explained by increasing participation in sport activities by the general population [9]. An Achilles tendon rupture can be career threatening for athletes as one-third of the national sport players who suffered an Achilles tendon rupture could never play at the same sports level again [11]. The most common location for Achilles tendon rupture is 3–6 cm above the calcaneal insertion [12, 13]. This can be partly explained by peak stresses in this midportion area of approximately 70 mega pascal (MPa), while most tendons experience peak stresses below 30 MPa [14]. These biomechanical models can explain why the Achilles tendon is prone to rupturing, but it remains largely unknown which determinants influence the risk of
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