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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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.
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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.
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The Danish National Committee on Health Research Ethics has stated that this registry study did not need approval to be initiated (Journal nr.: 17024868).
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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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DOI: https://doi.org/10.1007/s00167-020-06003-7