Skip to main content
SpringerLink
Log in

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

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. 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):629–633

    Article  PubMed  Google Scholar 

  2. 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 21:791–799

    Article  CAS  PubMed  Google Scholar 

  3. Danmarks Statistik (2014) Statistikbanken-Danmarks Statistik. http://www.statistikbanken.dk/statbank5a/default.a. Accessed 01 Oct 2014

  4. Datatilsynet (2014) Datatilsynet: introduction to the Danish data protection agency. http://www.datatilsynet.dk/english/. Accessed 01 Oct 2014

  5. Houshian S, Tscherning T, Riegels-Nielsen P (1998) The epidemiology of Achilles tendon rupture in a Danish county. Injury 29:651–654

    Article  CAS  PubMed  Google Scholar 

  6. 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 42:2419–2423

    Article  PubMed  Google Scholar 

  7. 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 36:765–773

    Article  PubMed  Google Scholar 

  8. 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 93:1071–1078

    Article  CAS  PubMed  Google Scholar 

  9. 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 30:783–790

    PubMed  Google Scholar 

  10. 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

    Google Scholar 

  11. Leppilahti J, Puranen J, Orava S (1996) Incidence of Achilles tendon rupture. Acta Orthop 67:277–279

    Article  CAS  Google Scholar 

  12. Levi N (1997) The incidence of Achilles tendon rupture in Copenhagen. Injury 28:311–313

    Article  CAS  PubMed  Google Scholar 

  13. 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 31:692–700

    PubMed  Google Scholar 

  14. 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  Google Scholar 

  15. Moller A, Westlin NE (1996) Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 67:479–481

    Article  CAS  PubMed  Google Scholar 

  16. Nillius AS, Nilsson BE, Westlin NE (1976) The incidence of Achilles tendon. Acta Orthop Scand 47:118–121

    Article  CAS  PubMed  Google Scholar 

  17. Nilsson Helander K, Olsson N, Eriksson BI, Karlsson J (2014) Individualiserad behandling viktig vid akut hälseneruptur. Lakartidningen 111:CXWT

    Google Scholar 

  18. 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 38:2186–2193

    Article  PubMed  Google Scholar 

  19. 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 97:272–275

    PubMed  Google Scholar 

  20. 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 41:2867–2876

    Article  PubMed  Google Scholar 

  21. Raikin SM, Garras DN, Krapchev PV (2013) Achilles tendon injuries in a United States population. Foot Ankle Int 34:475–480

    Article  PubMed  Google Scholar 

  22. Scott A, Grewal N, Guy P (2014) The seasonal variation of Achilles tendon ruptures in Vancouver, Canada: a retrospective study. BMJ Open. doi:10.1136/bmjopen-2013-004320

    Google Scholar 

  23. Suchak AA, Bostick G, Reid D, Blitz S, Jomha N (2005) The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int 26:932–936

    PubMed  Google Scholar 

  24. Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important?: a randomized prospective study. Am J Sports Med 35:2033–2038

    Article  PubMed  Google Scholar 

  25. 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 34:49–53

    PubMed  Google Scholar 

  26. 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 92:2767–2775

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Ann Ganestam, Anders Troelsen & Kristoffer Weisskirchner Barfod

  2. Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    Thomas Kallemose

Authors
  1. Ann Ganestam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Kallemose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anders Troelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristoffer Weisskirchner Barfod
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann Ganestam.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ganestam, A., Kallemose, T., Troelsen, A. et al. 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. Knee Surg Sports Traumatol Arthrosc 24, 3730–3737 (2016). https://doi.org/10.1007/s00167-015-3544-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3544-5

Keywords

Search

Navigation