The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients.
Level 3 - non-randomized controlled study
Population-based retrospective cohort / administrative database study
PubMed 28053261 · doi:10.1302/0301-620X.99B1.BJJ-2016-0434.R1
What was done
Administrative databases in Ontario, Canada, were analyzed to identify patients aged ≥ 18 years presenting to an emergency department with an acute Achilles tendon rupture (AATR) between January 1, 2003, and December 31, 2013. The researchers calculated overall and annual incidence density rates (IDR) across demographic subgroups and evaluated temporal trends in the rate of surgical repair.
What was found
A total of 27,607 patients were identified (median age 44 years, IQR 26 to 62; 66.5% male). Between 2003 and 2013, the annual IDR rose from 18.0 to 29.3 per 100,000 person-years, with the highest mean IDR observed among men aged 40 to 49 years (46.0 per 100,000 person-years). Over the same period, the annual surgical repair rate fell from 20.1 to 9.2 per 100 AATRs, with a pronounced decline occurring after 2009.
Why it matters
The study demonstrates a substantial population-level shift away from operative repair toward non-operative management of acute Achilles tendon ruptures, coinciding temporally with the publication of landmark randomized controlled trials supporting functional non-operative protocols.
Limits
The findings rely on administrative billing codes from emergency department visits, which carry risks of coding misclassification and missed outpatient presentations. The dataset does not provide clinical outcome measures, re-rupture rates, specific rehabilitation protocols, or details regarding patient-reported function.
Cited by
- supports Approximately 1 in 5,000 people rupture their Achilles tendon.