Analysis of hereditary and medical risk factors in Achilles tendinopathy and Achilles tendon ruptures: A matched pair analysis

Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Archives of Orthopaedic and Trauma Surgery (Impact Factor: 1.6). 02/2012; 132(6):847-53. DOI: 10.1007/s00402-012-1476-9
Source: PubMed


In Achilles tendon injuries, it is suggested that a pathological continuum might be evident from the healthy Achilles tendon to Achilles tendinopathy to Achilles tendon rupture. As such, risk factors for both tendinopathy and rupture should be the same.
Hereditary and medical risk factors for Achilles tendinopathy and Achilles tendon rupture are the same to a similar extent in a matched pair analysis.
Matched pair study; level of evidence: 3.
Recreational sportsmen as well as athletes on national level.
566 questionnaires were analysed. 310 subjects were allocated to 3 groups (A, B, C) after matching the pairs for age, weight, height and gender: (A) healthy Achilles tendons (n = 89, age 39 ± 11 years, BMI 25.1 ± 3.9, females 36%), (B) chronic Achilles tendinopathy (n = 161, age 41 ± 11 years, BMI 24.4 ± 3.7, females 34%), (C) acute Achilles tendon rupture (n = 60, age 40 ± 9 years, BMI 25.2 ± 3.2, females 27%).
We found a positive family history of Achilles tendinopathy as a risk factor for Achilles tendinopathy (OR: 4.8, 95% CI: 1.1-21.4; p = 0.023), but not for Achilles tendon rupture (OR: 4.0, 95% CI 0.7-21.1, p = 0.118). Smoking and cardiac diseases had a lower incidence in Achilles tendinopathy than in healthy subjects (both p = 0.001), while cardiovascular medication did not change the risk profile.
Identifying risk factors associated with Achilles tendon disorders has a high clinical relevance regarding the development and implementation of prevention strategies and programs. This cross-sectional study identified a positive family history as a significant solitary risk factor for Achilles tendinopathy, increasing the risk fivefold. However, in this matched pair analysis excluding age, weight, height and gender as risk factors no further factor necessarily increases the risk for either Achilles tendinopathy or Achilles tendon rupture.

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    • "Recently a study suggested that the ability of the Achilles tendon to adapt in response to loading such as running is attenuated in women[51]; another one showed that symptomatic females suffering Achilles tendinopathy do not benefit as much as symptomatic males from eccentric training[52]. A recent paper stated that male gender and age are not significant risk factors for development of Achilles tendon tendinopathy[53]. Body Weight: Obesity lead people to reduce physical activity: lack of training with loss of muscular compensation or forefoot disorders favor overuse problems[54]. "

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    • "Research suggests a genetic predisposition to increased risk of Achilles tendon injury (Katz and Mubarak, 1984; Kraemer et al., 2012; Ribbans and Collins, 2013). Between the sexes, males have been identified as most at risk of Achilles tendon injury by a factor of 2:1 to 12:1 to their female counterparts (Hess, 2010; Houshian et al., 1998; Soma and Mandelbaum, 1994; Vosseller et al., 2013). "
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    ABSTRACT: Recreational running is an activity with multiple reported health benefits for both sexes, however, chronic injuries caused by excessive and/or repetitive loading of the Achilles tendon are common. Males have been identified as being at an increased risk of suffering an injury to the Achilles tendon and as such, knowledge of differences in loading between the sexes may provide further information to better understand why this is the case. The aim of the current investigation was to determine whether gender differences in the Achilles tendon load exist in recreational runners. Fifteen male (age 26.74 ± 5.52 years, body height 1.80 ± 0.11 m and body mass 74.22 ± 7.27 kg) and fifteen female (age 25.13 ± 6.39 years, body height 1.68 ± 0.12 m and body mass 67.12 ± 9.11 kg) recreational runners volunteered to take part in the current investigation. Participants completed 10 trials running at 4.0 m·s-1 ±5% striking a force platform (1000 Hz) with their right foot. Ankle joint kinematics were synchronously recorded (250 Hz) using an optoelectric motion capture system. Ankle joint kinetics were computed using Newton-Euler inverse-dynamics. Net external ankle joint moments were then calculated. To estimate Achilles tendon kinetics the plantarflexion moment calculated was divided by an estimated Achilles tendon moment arm of 0.05 m. Differences in Achilles tendon kinetics were examined using independent sample t-tests (p<0.05). The results indicate that males were associated with significantly (p<0.05) greater Achilles tendon loads than females. The findings from this study support the notion that male recreationa lrunners may be at greater risk of Achilles tendon pathology.
    Full-text · Article · Dec 2014 · Journal of Human Kinetics
    • "Hormone replacement therapy has been shown to cause less tendon thickening compared with controls (Cook et al., 2007). Loss of estrogen is thought to result in poorer tendon health (Gaida et al., 2008) Smoking Smoking appears to be associated with a lower incidence of Achilles tendinopathy (Kraemer et al., 2012) Central adiposity A waist-girth score > 83 cm resulted in a 74% chance of having signs of PT on imaging (Malliaras et al., 2007) Treatment may be less effective in those with high adiposity levels (Gaida et al., 2009) Family history of tendon disorders A positive family history has been identified as a risk factor (Kraemer et al., 2012) "
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    ABSTRACT: The VISA-P is a questionnaire for assessing the severity of patellar tendinopathy (PT). Our study aim was to evaluate the equivalence of self-administration of the VISA-P online with the addition of risk factor questions to develop a tool suitable for high-volume remote use. A crossover study design with 107 subjects was used to determine equivalence between online and clinician administration. Three population groups were used to ensure construct validity. Online vs clinician administration revealed an intraclass correlation (ICC) of 0.79 [confidence interval (CI): 0.68-0.86] for the VISA-P with a systematic significant difference of 4.99, which is not clinically meaningful. Poor ICCs were seen for questions 7 and 8 of the VISA-P (0.37 and 0.47, respectively) in comparison with earlier questions. There were statistically significant differences between population groups for the VISA-P. The ICC for risk factor questions was excellent at 0.89 (CI: 0.84-0.93) with no mean difference (P = 1.00). The online questionnaire enables equivalent collection of VISA-P data and risk factor information and may well improve further with the suggested modifications to the instructions for questions 7 and 8. There is potential to use this questionnaire electronically to generate large databases in future research. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    No preview · Article · Nov 2014 · Scandinavian Journal of Medicine and Science in Sports
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