Gender Differences in Outcome After an Acute Achilles Tendon Rupture

OBJECTIVES: There is an indication in the literature that there is a difference in tendon healing between genders. However comparisons in outcome are often not possible due to the small sample size of women with an acute Achilles tendon rupture. In most studies on patients with Achilles tendon rupture the women only account for less then 20% of the patients. The objective of this study was to evaluate if there are any differences in outcome between genders when combining the data from two large randomized controlled trials, which used identical outcome measures. METHODS: Patients included in two consecutive randomized controlled trials, comparing surgical and non-surgical treatment, were included in the evaluation. Patients who had a re-rupture were excluded from the analysis. A total of 184 patients (154 males, 30 females) mean (SD) age of 40 (11) years were included. 96 (78 males, 18 females) were treated with surgery and 88 (76 males, 12 females) non-surgically. Patient reported outcome was evaluated with the Achilles tendon Total rupture Score (ATRS) and the functional outcome were measured with a single-leg standing heel-rise test (measurement of muscular endurance and heel-rise height) 6 and 12 months after injury in our research laboratory. RESULTS: For the whole group there were no significant difference between treatments on ATRS at 6 and 12 months. The surgical group was significantly better then the non-surgical group in heel-rise endurance at 6 and 12 months and in heel-rise height recovery at 6 months (p<0.03). When comparing the genders, disregarding the treatment, there were no significant differences except for at 12 months the males had a greater improvement in heel-rise height (p=0.004). When comparing the genders for each treatment group separately it was found that the females had significantly (p<0.04) more symptoms after surgical treatment (mean (SD) ATRS 61 (24)) compared to the males (74 (19)) at 6 months and (74 (27) vs. 87 (17)) at 12 months. This difference was not found when comparing the genders in the non-surgical treatment group. CONCLUSION: Females has a greater degree of deficit in heel-rise height as compared to males irrespective of treatment. Females have more symptoms compared to males after surgery both at 6 and 12 months but this difference is not found when treated non-surgically. Further research is needed to determine if women will benefit more from non-surgical compared to surgical treatment after an Achilles tendon rupture.