Incidence of Postoperative Rerupture of Achilles Tendon and Associated Risk Factors in South Korea: A National Population-Based Study

Abstract

Category: Sports; Ankle Introduction/Purpose: Achilles tendon rerupture (ATRR) is a frequently occurring complication following the treatment of an Achilles tendon rupture (ATR) that can lead to disability; however, comprehensive risk factors for the development of postoperative ATRR remain unclear. We aimed to determine the incidence rate of postoperative ATRR and its associated risk factors, including comorbidities and medication, among the South Korean population. Methods: This study was performed based on Health Insurance Review and Assessment claims data, which covers 98% of the overall Korean population. Patients with ATR were identified according to the disease code S86.0 (Achilles tendon injury) of the Korean classification of disease between 2007 and 2020, and a washout period of 1 year was set. Instances of reoperation on the Achilles tendon between 42 and 365 days after the initial surgery, in the absence of infection or skin necrosis, were classified as cases of Achilles tendon rerupture (ATRR). Data on age, sex, comorbidities, and medications were collected and statistically analyzed. Results: Between 2009 and 2018, the incidence of surgical treatment for primary ATR was 9.91 per 100,000 person-years, showing a significant annual increase. The postoperative rerupture rate was 2.14% and did not show a significant increase. Male sex, young age, preexisting Achilles tendinopathy, osteoarthritis, and preoperative exposure to non-steroidal anti-inflammatory drugs and opioids were risk factors for postoperative ATRR. Conclusion: This information needs to be considered when determining the surgical treatment for patients with Achilles tendon rupture. The study results provoke further biological and clinical research on the risk factors for postoperative ATRR.