Materiały źródłowe

• #1 The Achilles tendon: Management of acute and chronic conditions

  https://www1.racgp.org.au/ajgp/2020/november/the-achilles-tendon

  The prevalence of acute and chronic conditions of the Achilles tendon is increasing among an ageing, active population. […] Incidence and prevalence of Achilles tendon injuries has increased in the past 30 years, thought to be due to a combination of an active, ageing population and increased participation in sport and exercise programs in general. […] Achilles tendon overuse injuries are common in runners, with an annual incidence of between 7% and 9% in high-level runners. […] Management of acute Achilles tendon ruptures continues to be debated, but there is emerging evidence that supervised non-operative management results in very good outcomes. […] Chronic tendinopathies, functional lengthening or rerupture usually can be treated with non-operative management. […] Clinicians need to be wary of the elevated risk of DVT and pulmonary embolus in the acute and post-operative setting.

• #2 Achilles Tendinopathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538149/

  The Achilles tendon has a cumulative lifetime injury incidence of approximately 24% in athletes. […] Running-related injuries have a prevalence between 11% and 85% or 2.5 to 59 injuries per 1,000 hours of running. […] Results from one study cite the frequency of Achilles tendinopathy to be 1 to 2% in elite adolescent athletes. […] Another study cited the frequency of injury as 9% in recreational athletes. […] The lifetime injury incidence of 2.35 per 1000 is strongly associated with sporting activities. […] This incidence increases in older men. […] The overall incidence rate of Achilles tendinopathy ruptures is 2.1 per 100,000 person-years, and most AT ruptures occur in males, with a 3.5:1 male-to-female ratio.

• #3

  https://journals.lww.com/jocs/fulltext/2016/13040/prevalence_of_achilles_tendinopathy_and_its.4.aspx

  Achilles tendinopathy (AT) is the most frequently reported injury related to the ankle and foot in different sports activities. […] This study investigated the prevalence of AT and its association with selected physical characteristics in a population of recreational sports participants in Lagos, Nigeria. […] Our findings show that 21% of the participants had AT. […] AT is common among recreational sports individuals in Lagos, Nigeria, age being a contributing factor while other physical characteristics had no impact. […] High incidence rates of 7.8 (per 1000 athlete-week exposure), 83.3 (per 1000 athlete-year exposure), and 107.1 (per 1000 athlete-season exposure) have been reported for AT among runners. […] An incidence rate of 2.35/1000 subjects was reported for this injury in the general population (21-60 years) as well.

• #4 Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9453689/

  This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.040.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.020.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.040.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.010.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.140.20) and (0.06; 95%CI, 0.020.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.040.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.020.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.

• #5 Achilles Tendinopathy | NHS Lanarkshire

  https://www.nhslanarkshire.scot.nhs.uk/services/physiotherapy-msk/achilles-tendinopathy/

  Achilles tendinopathy affects 150,000 people within the UK every year. It is most common in people between the ages of 30 and 50 years, however, it can occur at any age. It is more common in men than women and can affect both athletes and people who are not as active. […] Tendinopathy is usually diagnosed by taking a medical history and clinical findings and rarely needs further investigations or scans. […] It is thought to be caused by repetitive stress and micro-trauma to the tendon as a result of a sudden increase in loading activities. A weakened or deconditioned tendon can be more easily injured. […] The repetitive stress and microtrauma causes the normal ability to heal to slow which results in a painful Achilles tendon.

• #6 Achilles tendinitis – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendinitis

  The prevalence of Achilles tendinitis varies among different ages and groups of people. Achilles tendinitis is most commonly found in individuals aged 30-40. Runners are susceptible, as well as anyone participating in sports, and men aged 30-39. […] Risk factors include participating in a sport or activity that involves running, jumping, bounding, and change of speed. Although Achilles tendinitis is mostly likely to occur in runners, it also is more likely in participants in basketball, volleyball, dancing, gymnastics and other athletic activities. […] Other risk factors include gender, age, improper stretching, and overuse. Another risk factor is any congenital condition in which an individual’s legs rotate abnormally, which in turn causes the lower extremities to overstretch and contract; this puts stress on the Achilles tendon and will eventually cause Achilles tendinitis.

• #7 Achilles tendinopathy – UpToDate

  https://www.uptodate.com/contents/achilles-tendinopathy-and-tendon-rupture

  Achilles tendinopathy affects competitive and recreational athletes as well as people who are not active. Observational data suggest that competitive athletes have a lifetime incidence of Achilles tendinopathy of 24 percent, with 18 percent sustained by athletes younger than 45 years. Achilles tendinopathy in recreational runners, although less likely to involve rupture, accounts for 6 to 17 percent of all running injuries. Military recruits develop tendinopathy at a rate of 6.8 percent. […] Although evidence is limited, a number of conditions and environmental exposures may be associated with an increased risk of developing Achilles tendinopathy. Cold-weather training is associated with higher rates of tendon pain generally and Achilles tendinopathy specifically. Additional risk factors associated with Achilles tendinopathy include the following.

• #8 Achilles Tendon Injuries: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/309393-overview

  The true incidence of Achilles tendinosis is unknown, although reported incidence rates are 6.5-18% in runners, 9% in dancers, 5% in gymnasts, 2% in tennis players, and less than 1% in American football players. It is estimated that Achilles disorders affect approximately 1 million athletes per year. […] The incidence of Achilles tendinosis is believed to be rising, in terms of tendinosis and acute ruptures. An estimated 10% of Americans are involved in some form of recreational running or in other jumping or pivoting activities, and often for longer periods than in previous generations. No data describe the incidence or prevalence of Achilles tendinosis, but it is known to affect 7-18% of club runners. […] Compared with females, Achilles tendon injuries are more prevalent in males by a ratio of 6:1, perhaps due to sports-specific involvement. These injuries usually are observed in recreational athletes aged 30-50 years. Many persons in this age group are active only intermittently but still challenge their bodies with high-force activities, predisposing them to Achilles tendinosis.

• #9 Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9453689/

  Our present meta-analysis found that there was no significant difference in the incidence of AT between genders. Contrary to our findings, previous reviews have shown significant gender differences in AT prevalence, with higher rates in men than in women. […] This study also has many limitations. First, significant heterogeneity was found in the overall assessment of the prevalence of AT from 16 included studies. This heterogeneity was consistent with our expectations. The differences in duration and intensity of various sports and individual characteristics of participants might lead to the high heterogeneity between studies. […] In conclusion, this systematic review and meta-analysis provide valuable insights into the prevalence of Achilles tendinopathy during exercise, which can be used as a reference risk for AT in specific sports at present, and can be used to compare the prevalence of AT in sports of different populations and types of sports. Our study suggests that it is necessary to pay more attention on AT in the people who are older or engaged in gymnastics.

• #10 Tendonitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/809692-overview

  Middle-aged adults are most susceptible to the development of tendinopathy. […] In general, the prognosis is very good with rest and conservative therapy. Chronic tendinopathy can lead to weakening of the tendon and subsequent rupture. […] The practical management of Achilles tendinopathy.

• #11 Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9453689/

  In recent years, the prevalence of AT has increased due to the increase in the number of people participating in PE. A large prospective cohort study found that the cumulative lifetime incidence of AT in male elite runners was more than 50%. A retrospective epidemiological study found that the incidence rate of AT in basketball athletes was 7.7%. In addition, an 11-year prospective follow-up study found that the incidence of AT in male professional football players reached 11.6%. […] Our study mainly found that the total prevalence of AT in PE was 6%, and the prevalence of Achilles tendon rupture was 3%. Subgroup analysis showed that the top two sport events with the highest prevalence of AT were gymnastics and ball games, the prevalence of AT was the highest in people aged over 45 years, reaching 8%, and the lowest in people younger than 18, only 2%. The prevalence of AT of athletes was higher than that of amateur exercisers. The prevalence of AT in Oceania is higher than that in Europe and America. There was no significant difference in the prevalence of AT between genders.

• #12 Prevalence and Risk Factors of Achilles Tendinopathy among University Soccer Players

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-8-223.php?jid=ijsem

  Tendinopathies especially that of the Achilles account for a significant amount of overuse injuries in sports that could hinder optimal performance in sport, might lead to permanent physical damage or disability, and it’s epidemiology is not extensively documented in our clime. Therefore, this study aimed to determine the prevalence and risk factors associated with Achilles Tendinopathy (AT) among university soccer players. […] The prevalence of AT was 21.9 per 100 persons. […] The prevalence of Achilles tendinopathy in university soccer players was high. […] The results depict that the higher the BMI, the likelihood of having AT. […] Therefore, point prevalence of Achilles tendinopathy in university soccer players is 21.9 per 100 persons. […] In this present study, the prevalence of Achilles tendinopathy in university soccer players is 21.9 per 100 persons.

• #13 Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners in: Journal of Applied Biomechanics Volume 39 Issue 4 (2023)

  https://journals.humankinetics.com/view/journals/jab/39/4/article-p237.xml

  The incidence of AT RRI in the observed participants over a 1-year prospective evaluation was 30%. […] The incidence of AT RRI in this study is significantly higher than in previous studies (7%-13%). […] Our data reported that the participants with AT RRI ran with greater ankle dorsiflexion and knee flexion angles during the stance phase. […] However, our logistic regression model highlighted that only knee flexion was a significant risk factor associated with the development of AT RRI. […] Each 1 increase in knee flexion is associated with a 15% increase in risk of AT RRI in healthy recreational runners.

• #14 Achilles tendinopathy – Part 1: Aetiology, diagnosis and non-surgical management

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2015000300003

  Achilles tendinopathy is most commonly seen in middle-and long-distance runners. It was also found to be the most frequently reported injury among master runners in a recent series. It is common in athletes who participate in track and field, soccer, tennis and other ball games that involve a large amount of running. In a recent paper on the epidemiology of Achilles tendinopathy, Jrvinen et al. reported an annual incidence of 7-9% in top-level runners. In this cohort, midsubstance disease dominated (55%-66%) followed by insertional conditions including retrocalcaneal bursitis (20%-25%). The condition is, however, not exclusive to athletes with 31% of patients in a recent series leading a sedentary lifestyle. […] While the exact aetiology of Achilles tendinitis remains unknown, repetitive tendon overload during vigorous training is generally regarded as the main culprit. Even within its physiological limits, repetitive strain can lead to microtrauma which, if not given sufficient time to heal, will lead to tendinopathy. Various predisposing factors have been identified. These can be classified either as intrinsic or extrinsic factors. A statistically significant association with the metabolic syndrome has been described, with almost 60% of patients with hyperlipidaemia or hypercholesterolaemia experiencing improvement in symptoms with lipid-lowering agents. The ABO blood groups A and O, use of the oral contraceptive pill and the post-menopausal state have also been implicated, and there is a well-known association with the use of fluoroquinolone antibiotics. Although the seronegative spondyloarthropathies are strongly associated with Achilles enthesopathy, it is seldom implicated (1%) in midsubstance disease and rupture. Of the intrinsic factors, lower limb malalignment, and especially hyperpronation of the forefoot, is the most commonly implicated. Leg length discrepancy, muscle weakness and imbalance, and increased weight are also important contributing factors. Extrinsic predisposing factors include sudden change in intensity and duration of training, poor technique, inappropriate footwear and running on hard, slippery or slanting surfaces. […] In Achilles tendinitis, repetitive tendon overload during vigorous training is generally regarded as the main culprit.

• #15 Achilles tendinopathy | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/achilles-tendinopathy?lang=us

  Achilles tendinopathy can affect a range of people, from athletes to recreational exercisers and even inactive people. In around one-third of cases, it affects non-athletes. […] Approximately 5% of patients with Achilles tendinopathy will go on to suffer an Achilles tendon rupture.

• #16 Biomedical Risk Factors of Achilles Tendinopathy in Physically Active People: a Systematic Review | Sports Medicine – Open | Full Text

  https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-017-0087-y

  Increased BMI and adverse lipid profile may be important biomarkers of Achilles tendinopathy. […] Further research is required to confirm an association between genetic variation, of genes encoding collagen proteins and proteins involved in pathways of tendon homeostasis and Achilles tendinopathy. […] Genetic risk factors of Achilles tendinopathy may be modified by geographic factors.

• #17

  https://journals.lww.com/jocs/fulltext/2016/13040/prevalence_of_achilles_tendinopathy_and_its.4.aspx

  Prior observational studies have shown that competitive athletes have a 24% lifetime incidence of AT, with an even higher incidence of 40-50% in competitive runners. […] AT accounts for 6-17% of all running injuries among recreational runners. […] One study in the Netherlands estimated the annual incidence of symptoms attributable to AT in the general population at 2.01/1000 people. […] There is dearth of data on the prevalence of AT in recreational sports in Nigeria hence the need for this study. […] In this study, age had a significant impact on the development of AT (P = 0.001) which supports the finding of Holmes and Lin that age has been indicated as an important factor that appears to predispose athletes to AT. […] Our findings also indicate that the physical characteristics of the participants such as weight, height, and body mass index (BMI) had no significant impact on the development of AT. […] A major strength of this study is that it has provided a preliminary data on the prevalence of AT in recreational sports persons in Lagos Nigeria.

• #18 Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners in: Journal of Applied Biomechanics Volume 39 Issue 4 (2023)

  https://journals.humankinetics.com/view/journals/jab/39/4/article-p237.xml

  However, running-related injuries (RRI) are reported by up to 79% of recreational runners and often result in individuals stopping or limiting their running. […] Achilles tendon (AT) pain is among the most common RRI, with an incidence of up to 22% among recreational runners. […] In the running population, males aged 30-50 years are the most susceptible to AT RRI. […] AT RRI is considered an overuse injury, and biomechanical overloading is believed to be the initiation of the injury. […] Different running biomechanics such as footfall patterns, running speed, or running in different conditions affect the AT loading during running. […] A large volume of published cross-sectional or retrospective studies have described the biomechanical factors associated with AT injuries in runners.

• #19

  https://biomedres.us/fulltexts/BJSTR.MS.ID.006614.php

  Compared to the general population with the same potentiating factors (age, sex, weight, height) there is increase risk of development of Achilles tendon injury among athletes with basketball being the most associated sporting activities in the United States. […] The mechanism of Achilles tendon injury can be described under the following: Overuse: Typical Mechanism of Injury: Achilles tendinitis usually develops from overuse. […] Recent research showed older age, higher android fat mass ratio, and waist circumference 83cm, in men is associated with a higher chance of having Achilles Tendinopathy. […] The presence of the COL5A1 gene variant was also found to be a possible risk factor. […] This research reveals the relationship between being athlete or military personnel and development of Achilles tendon injury as seen in the prevalence of the condition among individuals with these professions.

• #20 Prevalence and Risk Factors of Achilles Tendinopathy among University Soccer Players

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-8-223.php?jid=ijsem

  The increased rate in this study may be due to lack of attending medical team and Physiotherapist for this school teams or neglect by the school body. […] The height of the participants significantly associated with Achilles tendinopathy and a cohort study also reported an increased height in patients with AT.

• #21 Achilles Tendinopathy | PM&R KnowledgeNow

  https://now.aapmr.org/achilles-tendinopathy/

  Achilles tendon pathology is associated with 50% of all sports related injuries. About 75% of Achilles tendon ruptures occur in middle aged men participating in sports. It is one of the most common musculoskeletal injuries seen in running sports, with an incidence of around 9.1% to 10.9% in runners. One study described the prevalence of non-insertional AT as 2.01 per 1000 patients. AT may cause 5% of professional athletes to end their careers. Up to 4% of active adults may have asymptomatic degeneration. Other causes of AT include fluoroquinolone use (0.2-2.0%) and systemic diseases (2.0 %) such as ankylosing spondylitis, psoriatic and rheumatoid arthritis. […] Training in inclement weather, excessive uphill or downhill running and physical deconditioning is associated with an increased risk of AT. Those at greater risk for Achilles tendon rupture tend to be older and less physically conditioned. Achilles tendinopathy is more common in men, and those with hypertension or rheumatologic disease. Individuals with flat feet, reduced ankle mobility, and decreased gluteal strength are also at higher risk. Lastly, steroid use increases the likelihood of AT.

• #22 Achilles tendinitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020

  The Achilles tendon weakens with age. That can make it easier to injure. This is true for people who play sports only on the weekends or who start running farther, faster or longer without building up over time. […] Factors that can raise the risk of Achilles tendinitis include: Age. Achilles tendinitis is more common with age. […] Achilles tendinitis can weaken the tendon. The weakness makes it more likely to tear, also called rupture. An Achilles rupture is a serious injury that often needs surgery to repair it. […] It may not be possible to prevent Achilles tendinitis. But here are some ways to reduce the risk: Increase your activity level slowly. If you’re just starting a new exercise, start slowly. Increase how long and hard you train little by little.

• #23

  https://www.orthobullets.com/evidence/32203618

  Achilles tendinopathy (AT) is a clinical term describing a nonrupture injury of the Achilles tendon where the patient presents with pain, swelling, and reduced performance and symptoms exacerbated by physical activity. About 52% of runners experience AT in their lifetime and in the United States military the rate of clinically diagnosed AT cases was 5/1000 person-yr in 2015. […] Prospective studies indicate that risk factors include female sex, black race, higher body mass index, prior tendinopathy or fracture, higher alcohol consumption, lower plantar flexion strength, greater weekly volume of running, more years of running, use of spiked or shock absorbing shoes, training in cold weather, use of oral contraceptives and/ or hormone replacement therapy, reduced or excessive ankle dorsiflexion range of motion, and consumption of antibiotics in the fluoroquinolone class. […] Ultrasound scans might be useful in predicting future AT occurrences.

• #24 Tendinopathy – Wikipedia

  https://en.wikipedia.org/wiki/Tendinopathy

  Tendon injury and resulting tendinopathy are responsible for up to 30% of consultations to sports doctors and other musculoskeletal health providers. Tendinopathy is most often seen in tendons of athletes either before or after an injury but is becoming more common in non-athletes and sedentary populations. […] For example, the majority of patients with Achilles tendinopathy in a general population-based study did not associate their condition with a sporting activity. […] In another study the population incidence of Achilles tendinopathy increased sixfold from 1979-1986 to 1987-1994. […] The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%.

• #25 Epidemiology of Achilles tendon rupture in the US | Lower Extremity Review Magazine

  https://lermagazine.com/article/epidemiology-of-achilles-tendon-rupture-in-the-us

  The etiology of Achilles tendon rupture is multifactorial, but the injury occurs most frequently in the athletic population. […] Current estimates show an incidence of 2.66 ruptures per 1000 person-years, or about 18 ruptures (range 8.3-24) per 100,000 population. […] Until recently, epidemiological studies on Achilles tendon ruptures have come from Europe, New Zealand, Canada, or military populations in the US. […] The largest demographic group in these studies were middle-aged men, and the injury was most frequently associated with athletic activity. […] This authors recent study on Achilles tendon demographics in the civilian US population retrospectively evaluated the demographics of 406 consecutive Achilles tendon ruptures. […] The majority (68%) of ruptures occurred during sports participation.

• #26 Epidemiology of Achilles tendon surgery in Italy: a nationwide registry study, from 2001 through 2015 | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03688-2

  This study aims (1) to estimate the yearly number of Achilles tendon (AT) surgeries in Italy from 2001 to 2015 based on official hospitalization records; (2) to investigate the eventual presence of geographical variation in equity in access to AT surgery between three macroregions of Italy (North, Center and South); (3) to perform statistical projections of the number of AT procedure volumes and rates based on these data. […] During the 15-year study period, 118,652 AT repair were performed in Italy, whose peak of incidence was in 2010. More than half of AT repairs was performed in the North of Italy (52.1%), while 27.2% was performed in the South of Italy and 20.6% Center of Italy. The projection model predicted a slight growth of 2.65% in 2025 in comparison with 2015. […] The current study provides detailed information about the national population-weighted incidence of AT surgery, distribution and projection.

• #27 Incidence, demographics, characteristics and management of acute Achilles tendon rupture: An epidemiological study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0304197

  The UK management of ATR is predominantly non-surgical. This contrasts with surgical management rates seen internationally. The immobilisation duration is consistent with published protocols in this region of the UK. There is a disparity with other regions in the UK which adopt longer immobilisation periods. […] The incidence rate of ATR in England is higher than previously reported elsewhere in the UK. There is a continuing trend towards increasing ATR incidence each year. Non-sporting mechanisms of injury are more common than previously reported and occur in an older population with greater number of comorbidities and medications.

• #27 Incidence, demographics, characteristics and management of acute Achilles tendon rupture: An epidemiological study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0304197

  Achilles tendon ruptures (ATR) can occur when tendon strain exceeds maximum tendon capacity. Common mechanisms for ATR include sudden or violent dorsiflexion of the ankle or a sporting acceleration-deceleration mechanism. ATR are the most common tendon ruptures accounting for 10.7% of all tendon and ligament injuries. Incidence rates range is 2.5-47 per 100,000 person-years in north America and Europe. ATR incidence is rising, with the most significant increase between the ages of 40-59. Significant variation in incidence occurs due to the population sampled (male/female), sample age, geographic range (local/regional/national), sampling setting (emergency department/medical database review) or time of sampling (season). UK ATR incidence increased from 613 per 100,000 person years from 1995 to 2019. However, this data represents ATR incidence in Scotland and a single NHS trust in England. Further incidence data is required to improve understanding of ATR incidence in England.

• #28 The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.99B1.BJJ-2016-0434.R1

  The aims of this study were to establish the incidence of acute Achilles tendon rupture (AATR) in a North American population, to select demographic subgroups and to examine trends in the management of this injury in the province of Ontario, Canada. […] A total of 27 607 patients (median age, 44 years; interquartile range 26 to 62; 66.5% male) sustained an AATR. The annual IDR increased from 18.0 to 29.3 per 100 000 person-years between 2003 and 2013. […] The incidence of AATR is increasing in Ontario, while the annual rate of surgical repair is decreasing. A sharp decline in the rate of surgical repair was noted after 2009. This coincided with the publication of several high-quality RCTs which showed similar outcomes for the functional non-operative management and surgical repair.

• #29 Management of Chronic Tendon Injuries | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0401/p486.html/1000

  Chronic tendon injuries are commonly presented to the primary care physician, and have a significant impact on the ability of patients to work, exercise, and perform routine daily activities. […] Eccentric exercise should be the first-line treatment for chronic midsubstance Achilles tendinopathy. […] For chronic midsubstance Achilles tendinopathy (symptoms lasting longer than six weeks) the preferred first-line treatment is an intense eccentric strengthening program of the gastrocnemius/soleus complex. […] Good-quality randomized controlled trials indicate that eccentric strengthening programs provide 60 to 90 percent improvement in pain and function. […] Eccentric rehabilitation may be helpful, but this type of therapy does not show the same degree of utility as in midsubstance injuries, with rates of improvement closer to 30 percent for insertional injuries.

• #30 Epidemiology of Achilles tendon rupture in the US | Lower Extremity Review Magazine

  https://lermagazine.com/article/epidemiology-of-achilles-tendon-rupture-in-the-us

  Among acute ruptures, 76% were appropriately diagnosed, but 96 patients were diagnosed at an average of 68 days (range, 28-240 days) after their injury. […] Given that previous research had found African American race is a predisposing factor for Achilles tendon ruptures, this study also looked at race, but no clear relationship was demonstrated. […] Although the studies mentioned above have increased understanding and awareness of predisposition to Achilles tendon rupture, there is scant evidence of specific ways to predict or prevent these injuries. […] The male weekend warrior—the middle-aged man who participates in athletic endeavors only on an occasional basis—is at greatest risk of rupturing his Achilles tendon. […] Most Achilles tendon injuries, but not all, occur during sports participation, with basketball, tennis, and football being the activities most commonly associated with ruptures in the US. […] Delay in making the diagnosis and initiating appropriate treatment can significantly affect outcome and increase morbidity associated with the injury. […] An Achilles tendon rupture in one limb increases the likelihood of a rupture on the contralateral side.

• #31 An Overview of Achilles Tendinopathy Management

  https://www.mdpi.com/2673-4036/1/4/17

  Staff involved in the management of AT face a serious challenge. In fact, the results even after surgery are different and the surgery itself requires prolonged rehabilitation. Moreover, symptoms can last between 3 to 12 months after starting treatment; in about 25% of patients, chronic tendinopathy related symptoms can be present even after 10 years. […] Given the high incidence of AT, the purpose of this work is to help the reader with an overview of the approach to the patient with AT, from diagnosis to the various therapeutic opportunities currently used and reported in the literature. We present an overview of the management, from diagnosis to treatment, of AT, with a specific focus on conservative management based on pivotal works retrieved from the following database: Pubmed, Google Scholar, PEDro, and Scopus.

• #32 Achilles tendon tear | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/achilles-tendon-tear?lang=us

  Achilles tendon tears are the most common tendon ruptures. They are commonly seen secondary to sports-related injuries, especially squash and basketball. […] Acute Achilles tendon ruptures occur ~30 times (range 2.5-50) per 100,000 person-years. Patients are typically active middle-aged (~40 years) males with a sport-related rupture, although non-sporting ruptures occur in an older population (~55 years). […] There are numerous recognized predisposing factors, including male sex: M:F = 30:1, Black race, intratendinous steroid injection, increasing age in the non-sporting population, systemic illnesses such as rheumatoid arthritis, renal transplant, inflammatory bowel disease, diabetes mellitus, systemic lupus erythematosus, gout, ochronosis, hyperparathyroidism, previous Achilles tendinopathy, increased Achilles tendon AP diameter, and medications like fluoroquinolone antibiotics and oral corticosteroids.

• #33

  https://link.springer.com/article/10.1007/s00167-021-06824-0

  The aim of this study was to describe the epidemiology of Achilles tendon re-rupture. […] Males were affected more commonly (OR=7.40, 95% CI 0.9160.15; p=0.034). […] Mean Achilles tendon re-rupture incidence was 0.94/100,000/year for all ages and 1.16/100,000/year for adults (18 years). […] The epidemiology of Achilles tendon re-rupture is described and known trends (e.g. male predilection) are confirmed, while other novel findings are described, including incidence of a small but significant number of late re-ruptures, occurring years after the primary injury and an increased incidence of re-rupture in less socioeconomically deprived patients. Younger age and traditional immobilising cast treatment of primary Achilles tendon rupture were independently associated with Achilles tendon re-rupture.

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