Incidence, Temporal Trends, and Surgical Shift of Achilles Tendon Rupture: A Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of population-based registry and incidence studies
PubMed 41933260 · doi:10.1007/s40279-026-02397-5
What was done
A systematic review and meta-analysis following PRISMA guidelines searched six databases (PubMed, CINAHL, Embase, Web of Science, Index Medicus, and Google Scholar) through April 2025 for population-based registry or representative sample studies reporting Achilles tendon rupture incidence. Random-effects models pooled incidence rates per 100,000 person-years, meta-regressions evaluated temporal trends and subgroup differences (sex, age, country, region, sport participation), and quadratic meta-regression examined trends in surgical treatment. Risk of bias was evaluated using the Joanna Briggs Institute tool.
What was found
Twenty-eight studies from 1950 to 2022 were included, representing over 630 million individuals and 568,000 rupture cases. The pooled global incidence was 15.7 per 100,000 person-years, rising from 6.1 in 1979 to 31.1 in 2021, reflecting an average annual increase of 2.7% (95% CI 2.0-3.3%). Males had a three-fold higher incidence than females (pooled ratio 3.18, 95% CI 2.50-4.04). Peak incidence occurred in males aged 30-49 years (42.6 per 100,000 person-years) and females aged 40-49 years (17.2 per 100,000 person-years). Approximately 68% of ruptures were sport-related. Surgical repair rates peaked in 2003 and declined thereafter, showing a shift toward conservative treatment over the last two decades.
Why it matters
This review establishes a six-decade rise in Achilles tendon rupture incidence, driven primarily by sport-related injuries in middle-aged men, while documenting a major global shift toward non-operative management since 2003.
Limits
The analysis is restricted to population registries and representative samples, which are disproportionately from high-income regions with established national health databases. Long-term temporal increases may be partly influenced by improved diagnostic coding and imaging over time rather than pure incidence changes alone. Functional outcomes and re-rupture rates across management strategies were not evaluated.
Cited by
- supports Approximately 1 in 5,000 people rupture their Achilles tendon.