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Diabetes and treatment with orally administrated corticosteroids negatively affect treatment outcome at follow-up after acute Achilles tendon rupture

Knee Surgery, Sports Traumatology, Arthroscopy volume 29, pages 1584–1592 (2021)Cite this article

Abstract

Purpose

Studies investigating the influence of comorbidities on patient-reported outcomes after acute Achilles tendon ruptures (ATR) are lacking. In this study, the aim was to investigate the effect of comorbidity and medical treatment on the patient-reported outcome measure Achilles tendon total rupture score (ATRS).

Methods

The study was performed as a registry study from the Danish Achilles tendon Database (DADB). In the DADB, ATRS was registered at baseline (prior to rupture), at 3–6 month, 1-year and 2-year follow-ups. The outcomes were ATRS at follow-up and the change in ATRS from baseline to follow-up. Variables of interest were diabetes, hypertension, rheumatic disease and treatment with orally administrated corticosteroids. Linear mixed-effects models including all follow-up time points in the same model were used adjusting for sex, age group, treatment (operative or non-operative) and the investigated comorbidities.

Results

Data were collected from 2012 to 2019. Two thousand and four patients with ATR were included. Patients with the investigated comorbidities and treatment with orally administrated corticosteroid scored 10.6–19.1 points lower in mean ATRS at baseline (prior to rupture) compared to patients without the respective disease or treatment. At follow-up, patients with diabetes (mean difference, [95% CI]) (− 6.2, [− 11.7; − 0.8]; P = 0.03) and patients in treatment with orally administrated corticosteroids (− 10.9, [− 16.2; − 5.7]; P < 0.01) had a statistically significantly worse ATRS than patients without the respective disease. However, change in ATRS from baseline to follow-up was not affected. Hypertension and rheumatic disease did not affect ATRS at follow-up but had a positive effect on change in ATRS (4.3, [0.5; 8.1]; P = 0.03) and (12.0, [5.0; 19.9]; P < 0.01), respectively. No other statistically significant differences were found.

Conclusion

This study showed that patients with diabetes, hypertension, rheumatic disease and patients in treatment with orally administrated corticosteroids had a lower ATRS at baseline (prior to the rupture) when compared to patients without the respective disease or treatment. Diabetes and treatment with orally administrated corticosteroids did negatively affect ATRS at follow-up, but none of the investigated comorbidities or treatment with orally administrated corticosteroids did negatively affect change in ATRS from baseline to follow-up.

Level of evidence

Level III.

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Fig. 1

Abbreviations

ATR:

Acute Achilles tendon rupture

ATRS:

Achille tendon total rupture score

DADB:

Danish Achilles tendon Database

BMI:

Body mass index

SD:

Standard deviation

IQR:

Inter quartile range

CI:

Confidence interval

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Acknowledgements

We would like to thank the following hospitals in Denmark that have contributed data to 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. Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark

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

  2. Department of Physiotherapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark

    Maria Swennergren Hansen

  3. Clinical Research Center, Copenhagen University Hospital, 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

The 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 have critically revised the manuscript and have approved the final version.

Corresponding author

Correspondence to Allan Cramer.

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Conflict of interest

KWB is paid consultant for DJO Nordic. The rest of the authors declare that they have no conflict of interests.

Ethical approval

Institutional review board (IRB) approval was given by the Ethical Review Board of the Capital Region of Denmark April 23 2020, registration no. H-20028216. Approval from the Danish Data Protection Agency of the Capital Region of Denmark was given March 11 2020, registration no. P-2020-238.

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Informed consent was obtained from all study participants.

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Cramer, A., Jacobsen, N.C., Hansen, M.S. et al. Diabetes and treatment with orally administrated corticosteroids negatively affect treatment outcome at follow-up after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 29, 1584–1592 (2021). https://doi.org/10.1007/s00167-020-06371-0

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Keywords

  • Acute Achilles tendon rupture
  • Achilles tendon
  • Tendon rupture
  • Comorbidity
  • Diabetes
  • Hypertension
  • Rheumatic disease
  • Corticosteroids
  • Treatment outcome
  • Patient reported outcome
  • ATRS