Acute Achilles tendon ruptures between 2002–2021: sustained increased incidence, surgical decline and prolonged delay to surgery—a nationwide study of 53 688 ruptures in Sweden

Abstract

IntroductionGiven the lack of consensus on optimal treatment strategies for acute Achilles tendon rupture (ATR), understanding temporal trends, treatment choice and demographic characteristics is important. Previous research suggests increasing incidence with declining surgical treatment. Current trends in Sweden are not known.Hypothesis/purposeTo assess how incidence rates, treatment trends and time from injury to surgery (TTS) of ATR have changed between 2002 and 2021 in Sweden, with particular attention to changes since 2012.Study designDescriptive epidemiology study.MethodsWe conducted a nationwide register-based study including all inpatients and outpatients ≥18 years of age with an ATR between 2002 and 2021 in Sweden.Results53 688 ATRs (78.5% men) were identified during the study period. 15 045 patients (81.5% men) were surgically treated within 30 days. The long-term incidence rate for ATR injury increased by 45%, from 28.8 in 2002 to 41.7 in 2021 per 100 000 person-years (p<0.0001). In the last 5 years of the study, there was a significant, continuing increase in ATR incidence by 21%, from 34.4 in 2017 to 41.7 in 2021 per 100 000 person-years (p<0.0001). The surgical incidence rates decreased from 13.4 to 6.0 per 100 000 person-years (p<0.0001). TTS increased from 0.6 days in 2002 to 5.1 in 2021 (p<0.0001).ConclusionThe observed increase in incidence rates and decrease in surgical treatment of ATR emphasise the need for evidence-based treatment and rehabilitation protocols for non-operated patients of all ages. A significant increase in time from injury to surgery was observed throughout the study period.