Poster 383: Incidence of Sports Related Tendon Ruptures in the United States

OBJECTIVES: Physical activity is known to have multiple beneficial health effects, including a reduced risk of cardiovascular disease, improved insulin sensitivity and cognitive function [1,2]. Sports participation inherently increases the risk of musculoskeletal injury, including tendon rupture [3]. Tendon ruptures can be debilitating injuries and often require multidisciplinary treatment and long recovery periods and potentially lead to significant reductions in quality of life, lost productivity, and considerable healthcare costs [4]. Previous studies have been focused primarily on specific types of tendon injuries and/or specific patient populations such as high-level athletes and military trainees, which is not generalizable to the US population [5-8]. There currently exist no updated, population-based studies describing the incidence and demographics of all athletic/sports-related tendon ruptures in the general US population. The purpose of this study was to describe the contemporary epidemiology of athletic tendon ruptures in the US in the most recent two decades using a nationally representative sample. METHODS: The NEISS database, a nationally representative sample of US hospital emergency departments was used to ascertain the incidence rates of various types of tendon ruptures in the Unites States. All cases from 2001-2020 were reviewed for case narratives to select only those cases with a clear diagnosis of an acute primary tendon rupture. After exclusions, a total of n=5,765 unweighted cases were identified, representing a national estimate of N=235,189 tendon ruptures (95% CI=186,833- 283,546). Finally, each case narrative was manually reviewed and cross-referenced with the case’s product codes to assign a primary injury mechanism to each patient record, and only those cases involving exercise-/sports-related injury mechanisms were included in the final analyses. Statistical analysis was performed using the survey data commands in Stata/IC, version 17.0 (StataCorp, College Station, TX, US), accounting for sample weights and the complex survey designs. The incidence rate (IR) of tendon ruptures and mechanism were calculated and chi-square tests were used to compare estimated IRs between groups. Student t-test/analysis of variance and design-adjusted Rao-Scott chi- square analysis was used for direct comparisons of means for continuous variables and proportions for categorical variables, respectively [9,10]. Temporal trends and annual percentage changes were assessed via regression analysis. RESULTS: An estimated total of 141,382 individuals (95% CI=107,478-175,286) presented to US EDs with a sports-related tendon rupture over the study period for an overall incidence of 22.9 Person-Years at-risk (PYR) (95% CI=17.4-28.3). Mean age was 37.7 years (95% CI=37.0-38.5). Peak incidence of tendon ruptures occurred in the fourth decade and persons aged 20-40 years accounted for a majority of cases (78.2%). Achilles tendon rupture was the most common injury, representing over half of all cases (55.9%). Basketball was the most common sports-related injury mechanism, accounting for more than one-third of all injuries (36.6%) and a common mechanism for all tendon ruptures of the lower extremity. For sports-related injuries involving upper extremity tendons, weight lifting was the most common mechanism for most, including biceps, rotator cuff, and triceps/pectoralis tendon ruptures. Nearly half of all injuries occurred in contact sports (46.8%). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (AAPC=1.9, 95% CI=1.0-2.8; P<0.01). For comparison, the annual incidence of all non-sports-related tendon ruptures also increased significantly over the same time period (AAPC=4.9, 95% CI=3.7-6.1; P<0.01), and in fact increased at a significantly higher rate than that of all sports-related ruptures (P<0.01). Complete national injury estimate data for each specific type of sport or recreational activity, overall and for each type of tendon rupture, is reported in the Supplement Tables (Supplement 5,6). CONCLUSIONS: Tendon ruptures can be debilitating injuries for all patients and can especially affect personal and team performance of competitive athletes to differing degrees depending on the athlete’s particular sport [11]. There is a paucity of population-based studies describing the incidence and demographics of all athletic/exercise-related tendon ruptures in the general US population. This study highlights an increasing annual incidence of athletic tendon ruptures over the last two decades in the US, primarily affecting males of many different age groups. The incidence of nearly all types of tendon ruptures was significantly higher in males when compared with females, which is generally consistent with previous studies involving other large patient populations [12-16]. Previous population-based studies demonstrating an increased incidence of tendon ruptures in recent years have attributed these trends in part to increased athletic participation among adults of various ages [16–18]. Our results show the same trends and are likely attributed to increased participation in athletics, as well as the growing popularity of unconventional sports.