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Pediatric Achilles Tendon Ruptures in the United States: an Evaluation of National Practice Patterns, Management
Harmon S Khela1, Monty S Khela2, Margaret A Bowen3
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Pediatric Achilles tendon ruptures are declining. Nonoperative management is preferred and shows low complication rates, suggesting careful consideration for surgical intervention in children.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Achilles tendon ruptures are uncommon in pediatric patients.
- Developing tissues present unique biomechanical challenges.
- Optimal pediatric management strategies require further investigation.
Purpose of the Study:
- Evaluate national trends in pediatric Achilles tendon rupture incidence and management.
- Compare short-term and long-term outcomes of operative versus nonoperative treatment.
- Analyze complication rates associated with different management approaches.
Main Methods:
- Retrospective cohort study utilizing the PearlDiver database (2016-2022).
- Inclusion of pediatric patients (0-18 years) diagnosed with Achilles tendon ruptures.
- Stratification by rupture type (open/closed) and management (operative/nonoperative), with follow-up for complications.
Main Results:
- 18,441 pediatric Achilles tendon ruptures identified; 88% in ages 10-18.
- Most ruptures were closed (99.2%) and treated nonoperatively (97.4%).
- Incidence declined 2016-2022; operative management showed higher complication rates (infections, nerve injury, wound issues, failure).
Conclusions:
- Pediatric Achilles tendon rupture incidence has decreased.
- Nonoperative management is the predominant approach with favorable outcomes.
- Judicious patient selection is crucial for operative Achilles tendon rupture treatment in pediatrics.
Background:
Achilles tendon ruptures, though uncommon in the pediatric population, present significant clinical challenges due to the unique biomechanical and physiological characteristics of developing tissues. While adult management is well studied, the optimal pediatric approach remains unclear, with limited large-scale studies on this topic. This study aims to evaluate national trends in the incidence and management of pediatric Achilles tendon ruptures in the United States and compare short-term complication rates and longterm outcomes between operative and nonoperative approaches.
Methods:
A retrospective cohort study using the PearlDiver database identified pediatric patients (ages 0-18) diagnosed with Achilles tendon ruptures from 2016 to 2022. Patients were stratified by rupture type (open vs. closed) and management (operative vs. nonoperative). Population-normalized incidence rates were assessed by age group. A subset with a minimum 2 years of follow-up was analyzed for complications, including 90-day infection, nerve injury, and wound complication rates, as well as two-year ankle fracture and failure rates. Statistical analyses included Student's t-tests, chisquare tests, and linear regression.
Results:
A total of 18,441 pediatric patients with Achilles tendon ruptures were identified. Most injuries (88.0%) were in the 10-18 year age group with an even distribution of males and females (50% each). Most ruptures were closed (99.2%) and managed nonoperatively (97.4%), with nonoperative treatment more common in closed vs. open ruptures (97.6% vs. 71.5%, p<0.001). From 2016 to 2022, rupture incidence declined across all age groups (p<0.05), most notably in ages 1014 (p=0.004). The distribution of operative vs. nonoperative management remained unchanged. Complication rates were higher in the operative cohort compared to the nonoperative cohort: infections (5.07% vs. 0.32%), nerve injuries (0.68% vs. 0.03%), wound complications (1.01% vs. 0.04%), two-year failure (5.74% vs. 0.10%), and ankle fracture (1.69% vs. 0.75%), though statistical comparison was limited by low event counts.
Conclusion:
The incidence of pediatric Achilles tendon ruptures has declined significantly over the past decade. Nonoperative management remains the dominant treatment approach and is associated with low complication and failure rates. These findings highlight the importance of careful patient selection for operative intervention.
Level Of Evidence:
III.
