Acute Achilles tendon rupture and chronic tendinopathy surgery: Same tendon, with sex and ethnicity differences

Abstract

Background: Although differences in Achilles tendon injuries have been described based on sex and ethnicity, their impact on surgical presentation patterns and outcomes remains underreported. This study aims to compare demographics and complications between patients who underwent surgery for acute Achilles tendon rupture with those for chronic tendinopathy. All patients were operated by a single surgeon in a metropolitan region in the western United States between June 2016 and June 2022.

Methods: A retrospective review of a prospectively collected data was conducted. Data included age, sex, ethnicity, surgical indication, return to activity (RTA), and complications (re-rupture, infection, suture reaction, venous thromboembolism). Statistical analyses included Student's t-test and Fisher's exact/Chi-square test, with a significance set at P < .05.

Results: A total of 186 patients (121 males, 65 females; mean age: 47.5 ± 14.6 years) were included. Males were significantly more likely to undergo surgery for acute Achilles tendon repair (93 males, 5 females; P < .0001). Females were more likely to undergo surgery for chronic Achilles tendon pathology (76 %). There were no significant sex-based differences in complications or return to activity. There were variations in ethnicity, with Asian patients having a higher likelihood of acute tendon repair (87 %) whereas White patients were more likely to undergo surgical intervention for chronic tendinopathy (89 %; P < .00001).

Conclusion: Males were significantly more likely to have operative intervention for acute Achilles rupture, while females more often underwent surgery for chronic tendinopathy. There were ethnic differences in presentation patterns. Complication rate postoperatively and return to activity following surgical intervention did not vary between sex or ethnicity.

Level of evidence: III; Retrospective comparative study.

Keywords: Achilles tendon rupture; Chronic Achilles tendinopathy; Complications; Ethnic differences; Foot and ankle surgery; Retrospective study; Return to activity; Sex differences; Tendon repair.