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. 2025 Aug 4;13(8):23259671251360402.
doi: 10.1177/23259671251360402. eCollection 2025 Aug.

Epidemiology of Acute Primary Tendon Ruptures Presenting to Emergency Departments in the United States

Joshua A Whitmore  1 , Joseph G Lyons  1 , Fehmi Berkay  1 , Arjun Minhas  1
Affiliations

Epidemiology of Acute Primary Tendon Ruptures Presenting to Emergency Departments in the United States

Joshua A Whitmore et al. Orthop J Sports Med. .

Abstract

Background: There is literature on epidemiologic trends in acute primary tendon ruptures. However, most of the data used in the literature is centered in Europe or Canada, whereas there has been little analysis of trends in primary tendon ruptures in the United States (US), especially data collected after 2010.

Purpose: To report the epidemiology of upper and lower extremity acute primary tendon ruptures presenting to emergency departments (ED) in the US and compare incidence ratios based on race using the National Electronic Injury Surveillance System (NEISS) Database.

Study design: Descriptive epidemiology study.

Methods: The NEISS database was queried for acute primary tendon ruptures in the US from 2001 to 2020. National estimates (N) and estimated incidence ratios (IR) reported as per 100,000 person-years at risk (PYR) for acute primary tendon ruptures were calculated using NEISS sample estimates (n) and US Census Bureau population estimates. Temporal trends in annual IRs throughout the study period were assessed with regression analyses.

Results: From 2001 to 2020, there were an N of 235,189 (95% CI, 186,833-283,546) ED visits for acute tendon ruptures in the US, which occurred in a population of 6,183,899,410 person-years for an overall IR of 3.80 PYR (95% CI, 3.02-4.59). Acute primary Achilles (38.2%), biceps brachii (16.2%), and patellar tendon (12.7%) ruptures were the most common injuries. Black patients had the highest overall IR, with an N of 38,679 ruptures (95% CI, 21,552-55,807) occurring in this group for an overall IR of 4.78 PYR (95% CI, 2.66-6.89). The IR of lower extremity tendon ruptures was significantly higher in Black patients, but did not differ for upper extremity tendon ruptures. The annual incidence of all tendon ruptures in the US increased significantly from 2001 to 2020, with an average annual percent of 3 (95% CI, 2.3-3.7; P < .0001).

Conclusion: Our study demonstrated that the IR of acute primary tendon ruptures presenting to the ED in the US has increased from 2001 to 2020. Black/African-American individuals have an increased IR compared with White populations.

Keywords: National Electronic Injury Surveillance System; epidemiology; rupture; sports; tendon.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study.

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