Department of Orthopaedic, Trauma & Sports Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta.
Faculty of Medicine and Surgery, Mater Dei Hospital, University of Malta, Block A, Level 0, Msida, MSD 2090, Malta.
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2457-2469. doi: 10.1007/s00167-021-06824-0. Epub 2022 Jan 12.
The aim of this study was to describe the epidemiology of Achilles tendon re-rupture. Secondary aims were to identify factors predisposing to increased Achilles tendon re-rupture risk, at the time of primary Achilles tendon rupture.
A retrospective review of all patients with primary Achilles tendon rupture and Achilles tendon re-rupture was undertaken. Two separate databases were compiled: the first included all Achilles tendon re-ruptures presenting during the study period and described epidemiology, mechanisms and nature of the re-rupture; the second was a case-control study analysing differences between patients with primary Achilles tendon rupture during the study period, who did, or did not, go on to develop re-rupture, with minimum review period of 1.5 years.
Seven hundred and eighty-three patients (567 males, 216 females) attended with primary Achilles tendon rupture and 48 patients (41 males, 7 females) with Achilles tendon re-rupture. Median time to re-rupture was 98.5 days (IQR 82-122.5), but 8/48 re-ruptures occurred late (range 3 to 50 years) after primary Achilles tendon rupture. Males were affected more commonly (OR = 7.40, 95% CI 0.91-60.15; 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). Age distribution was bimodal for both primary Achilles tendon rupture and re-rupture, peaking in the fifth decade, with secondary peaks in older age. Incidence of re-rupture was higher in less socioeconomically deprived sub-populations (OR = 2.01, 95%CI 1.01-3.97, p = 0.04). The majority of re-ruptures were low-energy injuries. Greater risk of re-rupture was noted for patients with primary rupture aged < 45 years [adjusted odds ratio (aOR) 1.96; p = 0.037] and those treated with traditional cast immobilisation (aOR 2.20; p = 0.050).
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.
III.
本研究旨在描述跟腱再断裂的流行病学。次要目的是确定导致跟腱初次断裂时再断裂风险增加的因素。
对所有初次跟腱断裂和跟腱再断裂患者进行回顾性研究。分别编制了两个数据库：第一个数据库包括研究期间发生的所有跟腱再断裂，并描述了再断裂的流行病学、机制和性质；第二个数据库是病例对照研究，分析了研究期间初次跟腱断裂患者中，是否发生再断裂的患者之间的差异，随访时间至少为 1.5 年。
783 名患者（567 名男性，216 名女性）就诊时发生初次跟腱断裂，48 名患者（41 名男性，7 名女性）发生跟腱再断裂。再断裂的中位时间为 98.5 天（IQR 82-122.5），但 8/48 例再断裂发生在初次跟腱断裂后 3-50 年（范围）的晚期。男性受影响更为常见（OR=7.40，95%CI 0.91-60.15；p=0.034）。所有年龄的平均跟腱再断裂发生率为 0.94/100000/年，成年人（≥18 岁）为 1.16/100000/年。初次跟腱断裂和再断裂的年龄分布呈双峰型，在第五个十年达到高峰，老年时出现第二个高峰。在社会经济地位较低的亚人群中，再断裂的发生率更高（OR=2.01，95%CI 1.01-3.97，p=0.04）。大多数再断裂为低能量损伤。初次断裂年龄<45 岁的患者（校正比值比[aOR]1.96；p=0.037）和接受传统石膏固定治疗的患者（aOR 2.20；p=0.050）发生再断裂的风险更高。
描述了跟腱再断裂的流行病学，证实了已知的趋势（例如男性偏好），同时还描述了一些新的发现，包括一小部分但数量相当可观的晚期再断裂的发生率，这些再断裂发生在初次损伤多年后，以及在社会经济地位较低的患者中，再断裂的发生率增加。初次跟腱断裂患者年龄较小和传统的固定石膏治疗与跟腱再断裂独立相关。
III 级。
