Sports Medicine

, Volume 44, Issue 9, pp 1241–1259 | Cite as

Predictors of Primary Achilles Tendon Ruptures

  • Femke M. A. P. Claessen
  • Robert-Jan de Vos
  • Max Reijman
  • Duncan E. MeuffelsEmail author
Systematic Review



The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing.


The aim of this review was to systematically summarize predictors influencing Achilles tendon rupture (ATR) risk.


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.


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.


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 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.


Vascular Endothelial Growth Factor Achilles Tendon Leukemia Inhibitor Factor Tendon Rupture Pentosidine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank G.B. de Jonge and W. Bramer, medical librarians of the Erasmus Medical Center in Erasmus MC, for assistance in performing the literature search.

No sources of funding were used to assist in the preparation of this review. The authors have no potential conflicts of interest that are directly relevant to the content of this review.


Femke Claessen, Duncan Meuffels, and Robert-Jan de Vos contributed to the conception and design of the study and to interpretation of the data. Femke Claessen drafted the article. Duncan Meuffels, Max Reijman and Robert-Jan de Vos revised the article for important intellectual comment. All authors gave final approval of the version to be submitted.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Femke M. A. P. Claessen
    • 1
  • Robert-Jan de Vos
    • 1
    • 2
  • Max Reijman
    • 1
  • Duncan E. Meuffels
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryErasmus MC, University Medical Centre RotterdamRotterdamThe Netherlands
  2. 2.Department of Sports MedicineThe Hague Medical CentreLeidschendamThe Netherlands

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