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Outcome after acute Achilles tendon rupture is not negatively affected by female sex and age over 65 years

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 3994–4002 (2020)Cite this article

Abstract

Purpose

Studies suggest that women have worse treatment outcome than men after acute Achilles tendon rupture (ATR). The aim of this study was to investigate if sex and age affect treatment outcome after ATR.

Methods

The study was performed as a registry study in the Danish Achilles tendon Database. The primary outcome was change in the Achilles tendon Total Rupture Score (ATRS) from baseline to 4 months, 1 year and 2 years follow-up. Variables of interest were sex and age group (< 40 years, 40–65 years and > 65 years).

Results

Data were collected from April 2012 to March 2018. Five-hundred and sixteen patients (416 men, 100 women) were included in the study population. At baseline, women scored 4.3 points lower in ATRS compared to men. No statistically significant difference between the sexes regarding change in ATRS were found. Women scored statistically significantly less in absolute ATRS at 1 year follow-up (mean difference 9.4; 95% CI 3.8, 14.9; P = 0.03). Patients older than 65 years scored statistically significantly more in ATRS change compared to patients between 40–65 years (mean difference 12.8; 95% CI 6.1–19.5; P < 0.001).

Conclusion

This study did not show a statistically significant or clinically relevant difference between the sexes in ATRS change from baseline to follow-up. The mean difference in ATRS change between patients older than 65 years and patients between 40–65 years was clinically relevant with better outcome for patients older than 65 years. When comparing ATRS between groups with an unequal sex distribution, the findings of a baseline difference and a difference in absolute ATRS at 1 year follow-up between the sexes, advocate for reporting of sex-specific data or for use of change in ATRS from baseline to follow-up instead of absolute ATRS.

Level of evidence

Level III.

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Fig. 1

Abbreviations

ATR:

Acute Achilles tendon rupture

ATRS:

Achilles tendon total rupture score

HRH:

Heel-rise height

ATRA:

Achilles tendon resting angle

DADB:

Danish Achilles tendon database

PROMs:

Patient reported outcome measures

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Acknowledgements

We would like to thank the following hospitals in Denmark who have contributed to data collection for the Danish Achilles tendon Database; Aalborg Hospital, Køge Hospital, Nykøbing Falster Hospital, Amager-Hvidovre Hospital, Kolding Hospital, Vendsyssel Hospital, Hjørring Hospital, Thy-Mors Hospital, Himmerland Farsø Hospital, Viborg Regional Hospital, Randers Regional Hospital and Slagelse Hospital.

Funding

No funds were received.

Author information

Affiliations

  1. Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Allan Cramer, Nanna Cecilie Jacobsen, Maria Swennergren Hansen, Per Hölmich & Kristoffer Weisskirchner Barfod

  2. Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen, Denmark

    Maria Swennergren Hansen

  3. Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Denmark

    Håkon Sandholdt

Authors
  1. Allan Cramer
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  2. Nanna Cecilie Jacobsen
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  3. Maria Swennergren Hansen
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  4. Håkon Sandholdt
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  5. Per Hölmich
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  6. Kristoffer Weisskirchner Barfod
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Contributions

All authors (AC, NCJ, MSH, HS, PH, KWB) designed the study and interpreted the data. AC, HS and KWB made the statistical analysis. AC and KWB wrote the first version of the manuscript. All authors critically revised the manuscript and have approved the final version.

Corresponding author

Correspondence to Allan Cramer.

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Conflict of interest

The authors declare that they have no competing interests. No benefits have been received or will be received from a commercial party related (in)directly of this article.

Ethical approval

The Danish National Committee on Health Research Ethics has stated that this registry study did not need approval to be initiated (Journal nr.: 17024868).

Informed consent

Informed consent was obtained from all study participants.

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Cramer, A., Jacobsen, N.C., Hansen, M.S. et al. Outcome after acute Achilles tendon rupture is not negatively affected by female sex and age over 65 years. Knee Surg Sports Traumatol Arthrosc 28, 3994–4002 (2020). https://doi.org/10.1007/s00167-020-06003-7

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Keywords

  • Achilles tendon rupture
  • ATR
  • Sex
  • Age
  • Treatment outcome
  • Achilles tendon total rupture score
  • ATRS
  • PROM