Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis

Yahai Wang, Huanhuan Zhou, Zhibin Nie, Sidong Cui

Sports Medicine and Health Science ›› 2022, Vol. 4 ›› Issue (3) : 152-159. DOI: 10.1016/j.smhs.2022.03.003
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Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis

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Abstract

This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1st of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.04-0.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.02-0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.04-0.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.01-0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.14-0.20) and (0.06; 95%CI, 0.02-0.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.04-0.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.02-0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.

Keywords

Achilles tendinopathy / Prevalence / Physical exercise / meta-Analysis

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Yahai Wang, Huanhuan Zhou, Zhibin Nie, Sidong Cui. Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis. Sports Medicine and Health Science, 2022, 4(3): 152‒159 https://doi.org/10.1016/j.smhs.2022.03.003

References

[[1]]
T.B. Cardoso, T. Pizzari, R. Kinsella, et al.. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol, 33 (1) ( 2019), pp. 122-140, DOI: 10.1016/j.berh.2019.02.001
[[2]]
2.B. Magnan M. Bondi S. Pierantoni, et al.. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg, 20 (3) ( 2014), pp. 154-159, DOI: 10.1016/j.fas.2014.02.010
[[3]]
S.B. Weinfeld. Achilles tendon disorders. Med Clin, 98 (2) ( 2014), pp. 331-338, DOI: 10.1016/j.mcna.2013.11.005
[[4]]
K.G. Silbernagel, S. Hanlon, A. Sprague. Current clinical concepts: conservative management of achilles tendinopathy. J Athl Train, 55 (5) ( 2020), pp. 438-447, DOI: 10.4085/1062-6050-356-19
[[5]]
N. Maffulli, U.G. Longo, A. Kadakia, et al.. Achilles tendinopathy. Foot Ankle Surg, 26 (3) ( 2020), pp. 240-249, DOI: 10.1016/j.fas.2019.03.009
[[6]]
R. Aicale, A. Oliviero, N. Maffulli.Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res, 13 (1) ( 2020), p. 59, DOI: 10.1186/s13047-020-00418-8
[[7]]
V. Pavone, A. Vescio, G. Mobilia, et al.. Conservative treatment of chronic achilles tendinopathy: a systematic review. J Funct Morphol Kinesiol, 4 (3) ( 2019), p. 46, DOI: 10.3390/jfmk4030046
[[8]]
A.A. Schepsis, H. Jones, A.L. Haas. Achilles tendon disorders in athletes. Am J Sports Med, 30 (2) ( 2002), pp. 287-305, DOI: 10.1177/03635465020300022501
[[9]]
U.G. Longo, S. Petrillo, N. Maffulli, et al.. Acute achilles tendon rupture in athletes. Foot Ankle Clin, 18 (2) ( 2013), pp. 319-338, DOI: 10.1016/j.fcl.2013.02.009
[[10]]
J.P. Deangelis, K.M. Wilson, C.L. Cox, et al.. Achilles tendon rupture in athletes. J Surg Orthop Adv, 18 (3) ( 2009), pp. 115-121
[[11]]
U.G. Longo, M. Ronga, N. Maffulli. Achilles tendinopathy. Sports Med Arthrosc Rev, 26 (1) ( 2018), pp. 16-30, DOI: 10.1097/jsa.0000000000000185
[[12]]
U.M. Kujala, S. Sarna, J. Kaprio. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med, 15 (3) ( 2005), pp. 133-135, DOI: 10.1097/01.jsm.0000165347.55638.23
[[13]]
P.R. Ames, U.G. Longo, V. Denaro, et al.. Achilles tendon problems: not just an orthopaedic issue. Disabil Rehabil, 30 (20-22) ( 2008), pp. 1646-1650, DOI: 10.1080/09638280701785882
[[14]]
D. Florit, C. Pedret, M. Casals, et al.. Incidence of tendinopathy in team sports in a multidisciplinary sports club over 8 seasons. J Sports Sci Med, 18 (4) ( 2019), pp. 780-788
[[15]]
M. Gajhede-Knudsen, J. Ekstrand, H. Magnusson, et al.. Recurrence of Achilles tendon injuries in elite male football players is more common after early return to play: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med, 47 (12) ( 2013), pp. 763-768
[[16]]
D.P. Trofa, J.C. Miller, E.S. Jang, et al.. Professional athletes' return to play and performance after operative repair of an achilles tendon rupture. Am J Sports Med, 45 (12) ( 2017), pp. 2864-2871, DOI: 10.1177/0363546517713001
[[17]]
M. Aström. Partial rupture in chronic achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand, 69 (4) ( 1998), pp. 404-407, DOI: 10.3109/17453679808999056
[[18]]
A.L.C. Martimbianco, R.E.S. Ferreira, C.O.C. Latorraca, et al.. Photobiomodulation with low-level laser therapy for treating Achilles tendinopathy: a systematic review and meta-analysis. Clin Rehabil, 34 (6) ( 2020), pp. 713-722, DOI: 10.1177/0269215520912820
[[19]]
F. Wilson, M. Walshe, T. O'Dwyer, et al.. Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. Br J Sports Med, 52 (24) ( 2018), pp. 1564-1574, DOI: 10.1136/bjsports-2017-098913
[[20]]
J.J. Knapik, R. Pope. Achilles tendinopathy: pathophysiology, Epidemiology, diagnosis, treatment, prevention, and screening. J Spec Oper Med, 20 (1) ( 2020), pp. 125-140
[[21]]
M. Simpson, E. Rio, J. Cook. At what age do children and adolescents develop lower limb tendon pathology or tendinopathy? A systematic review and meta-analysis. Sports Med, 46 (4) ( 2016), pp. 545-557, DOI: 10.1007/s40279-015-0438-0
[[22]]
D. Moher, A. Liberati, J. Tetzlaff, et al.. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6 (7) ( 2009), Article e1000097, DOI: 10.1371/journal.pmed.1000097
[[23]]
E. von Elm, D.G. Altman, M. Egger, et al.. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, 370 (9596) ( 2007), pp. 1453-1457, DOI: 10.1016/s0140-6736(07)61602-x
[[24]]
C.K. Lo, D. Mertz, M. Loeb.Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Med Res Methodol, 14 ( 2014), p. 45, DOI: 10.1186/1471-2288-14-45
[[25]]
J.P. Higgins, S.G. Thompson, J.J. Deeks, et al.. Measuring inconsistency in meta-analyses. BMJ, 327 (7414) ( 2003), pp. 557-560, DOI: 10.1136/bmj.327.7414.557
[[26]]
C. Serban, A. Sahebkar, S. Ursoniu, et al.. Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens, 33 (6) ( 2015), pp. 1119-1127, DOI: 10.1097/hjh.0000000000000585
[[27]]
J. Bonanno, J. Cheng, D. Tilley, et al.. Factors associated with achilles tendon rupture in women’s collegiate gymnastics. Sport Health, 14 (3) ( 2022), pp. 358-368, DOI: 10.1177/19417381211034510
[[28]]
M. Cassel, H. Baur, A. Hirschmüller, et al.. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports, 25 (3) ( 2015), pp. e310-e318, DOI: 10.1111/sms.12318
[[29]]
M. Cassel, L. Risch, K. Intziegianni, et al.. Incidence of achilles and patellar tendinopathy in adolescent elite athletes. Int J Sports Med, 39 (9) ( 2018), pp. 726-732, DOI: 10.1055/a-0633-9098
[[30]]
J. Comin, J.L. Cook, P. Malliaras, et al.. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study. Br J Sports Med, 47 (2) ( 2013), pp. 89-92, DOI: 10.1136/bjsports-2012-091303
[[31]]
C. Emerson, D. Morrissey, M. Perry, et al.. Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls - an observational study. Man Ther, 15 (1) ( 2010), pp. 37-42, DOI: 10.1016/j.math.2009.05.008
[[32]]
B. Ganse, H. Degens, M. Drey, et al.. Impact of age, performance and athletic event on injury rates in master athletics - first results from an ongoing prospective study. J Musculoskelet Neuronal Interact, 14 (2) ( 2014), pp. 148-154
[[33]]
L.C. Hespanhol Junior, L.O. Costa, A.C. Carvalho, et al.. A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study. Rev Brasileira Fisioterapia, 16 (1) ( 2012), pp. 46-53
[[34]]
K.J. Hunt, D. Hurwit, K. Robell, et al.. Incidence and Epidemiology of foot and ankle injuries in elite collegiate athletes. Am J Sports Med, 45 (2) ( 2017), pp. 426-433, DOI: 10.1177/0363546516666815
[[35]]
I.F. Lagas, T. Fokkema, J.A.N. Verhaar, et al.. Incidence of Achilles tendinopathy and associated risk factors in recreational runners: a large prospective cohort study. J Sci Med Sport, 23 (5) ( 2020), pp. 448-452, DOI: 10.1016/j.jsams.2019.12.013
[[36]]
U.G. Longo, J. Rittweger, G. Garau, et al.. No influence of age, gender, weight, height, and impact profile in achilles tendinopathy in masters track and field athletes. Am J Sports Med, 37 (7) ( 2009), pp. 1400-1405, DOI: 10.1177/0363546509332250
[[37]]
R.O. Nielsen, L. Rønnow, S. Rasmussen, et al.. A prospective study on time to recovery in 254 injured novice runners. PLoS One, 9 (6) ( 2014), Article e99877, DOI: 10.1371/journal.pone.0099877
[[38]]
C.C. Ooi, M.E. Schneider, P. Malliaras, et al.. Sonoelastography of the achilles tendon: prevalence and prognostic value among asymptomatic elite Australian rules football players. Clin J Sport Med, 26 (4) ( 2016), pp. 299-306, DOI: 10.1097/jsm.0000000000000265
[[39]]
A. Van Ginckel, Y. Thijs, N.G. Hesar, et al.. Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture, 29 (3) ( 2009), pp. 387-391, DOI: 10.1016/j.gaitpost.2008.10.058
[[40]]
R.J. Walls, S.A. Brennan, P. Hodnett, et al.. Overuse ankle injuries in professional Irish dancers. Foot Ankle Surg, 16 (1) ( 2010), pp. 45-49, DOI: 10.1016/j.fas.2009.05.003
[[41]]
M. Simpson, E. Rio, J. Cook. At what age do children and adolescents develop lower limb tendon pathology or tendinopathy? A systematic review and meta-analysis. Sports Med, 46 (4) ( 2016), pp. 545-557, DOI: 10.1007/s40279-015-0438-0
[[42]]
A.L. Barrios-Cárdenas, J.O. Lazo-Vera. [Epidemiological, clinical and therapeutic characteristics of Achilles tendon rupture]. Acta Ortop Mex, 35 (3) ( 2021), pp. 252-256
[[43]]
R.P. Hubbard, R.W. Soutas-Little. Mechanical properties of human tendon and their age dependence. J Biomech Eng, 106 (2) ( 1984), pp. 144-150, DOI: 10.1115/1.3138471
[[44]]
A.L. Sprague, D. Awokuse, R.T. Pohlig, et al.. Relationship between mechanical properties (shear modulus and viscosity), age, and sex in uninjured Achilles tendons. Transl Sports Med, 3 (4) ( 2020), pp. 321-327, DOI: 10.1002/tsm2.148
[[45]]
A.C. Vailas, V.A. Pedrini, A. Pedrini-Mille, et al.. Patellar tendon matrix changes associated with aging and voluntary exercise. J Appl Physiol, 58 (5) ( 1985), pp. 1572-1576, DOI: 10.1152/jappl.1985.58.5.1572
[[46]]
E. Ippolito, P.G. Natali, F. Postacchini, et al.. Morphological, immunochemical, and biochemical study of rabbit achilles tendon at various ages. J Bone Joint Surg Am, 62 (4) ( 1980), pp. 583-598
[[47]]
I. Lantto, J. Heikkinen, T. Flinkkilä, et al.. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports, 25 (1) ( 2015), pp. e133-e138, DOI: 10.1111/sms.12253
[[48]]
G.W. Hess. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec, 3 (1) ( 2010), pp. 29-32, DOI: 10.1177/1938640009355191
[[49]]
J.J. Chan, K.K. Chen, S. Sarker, et al.. Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States. Int Orthop, 44 (3) ( 2020), pp. 585-594, DOI: 10.1007/s00264-019-04471-2
[[50]]
E. Wezenbeek, D. De Clercq, N. Mahieu, et al.. Activity-induced increase in achilles tendon blood flow is age and sex dependent. Am J Sports Med, 46 (11) ( 2018), pp. 2678-2686, DOI: 10.1177/0363546518786259
[[51]]
M. Macchi, M. Spezia, S. Elli, et al.. Obesity increases the risk of tendinopathy, tendon tear and rupture, and postoperative complications: a systematic review of clinical studies. Clin Orthop Relat Res, 478 (8) ( 2020), pp. 1839-1847, DOI: 10.1097/corr.0000000000001261
[[52]]
C. Emerson, D. Morrissey, M. Perry, et al.. Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls--an observational study. Man Ther, 15 (1) ( 2010), pp. 37-42, DOI: 10.1016/j.math.2009.05.008
[[53]]
I. Cristi-Sánchez, C. Danes-Daetz, A. Neira, et al.. Patellar and achilles tendon stiffness in elite soccer players assessed using myotonometric measurements. Sport Health, 11 (2) ( 2019), pp. 157-162, DOI: 10.1177/1941738118820517
[[54]]
N.H. Amin, K.C. McCullough, G.L. Mills, et al.. The impact and functional outcomes of achilles tendon pathology in national basketball association players. Clin Res Foot Ankle, 4 (3) ( 2016), p. 205, DOI: 10.4172/2329-910x.1000205
[[55]]
K.T. Lee, J. Hyuk, S.J. Kim. Return to play after open calcaneoplasty for insertional achilles tendinopathy with haglund deformity in competitive professional athletes. Orthop J Sports Med, 9 (6) ( 2021), Article 23259671211009820, DOI: 10.1177/23259671211009820

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