Is high concentration of serum lipids a risk factor for Achilles tendon rupture?

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Abstract

Background: The incidence of the Achilles tendon ruptures (ATR) seems to be increasing due to changes in life style and intensified sports activities in recent years. Intrinsic and extrinsic factors have been implicated as predisposing risk factors to rupture. The purpose of this study was to investigate whether the high serum lipid concentrations could be an intrinsic factor in patient with complete ruptures of Achilles tendon. Methods: The data were collected from the records of 47 patients with complete rupture of Achilles and the control group consisted of 26 subjects. Results: Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) concentrations of the patients with ATR were higher (p<0.001), and their high-density lipoprotein cholesterol (HDL-C) was lower than the control group (p<0.05). Moreover, the concentrations of triglyceride (TG) and very low-density lipoprotein cholesterol (VLDL-C) were significantly higher than controls (p<0.05). Conclusions: The causes of ATR are multifactorial and still unclear. However, high serum lipid concentrations might be considered, as a predisposing factor in patients with complete rupture of Achilles tendon and further investigations with larger groups would be better.

Introduction

Although the real incidence of Achilles tendon ruptures (ATR) in the society is not known, it is observed that it has increased in recent years [1], [2], [3]. One of the reasons might be the advance in medicine; especially recent advances in the development of medical diagnostic methods have provided easy recognition of ATR cases [4]. ATR has been found out that it occurs during participation in a sports activity (3–44%) [5], is seen in men more than in women (1.7/1–12/1) [6], occurs usually in the third or fourth decade of life [1], and is generally right-sided [6]. The etiologies of ATR are multifactorial. In the great majority of spontaneous ATR, chronic degenerative changes play main role [7]. Moreover, O blood group [8], inflammatory, autoimmune, genetic, infectious, neurological disorders and some drugs are blamed of the other factors for ATR [6]. In some studies it is claimed that, there might be a relation between ATR and serum lipid profiles [9], [10], [11], [12], [13]. In this study, we aimed to investigate the relation between ATR and serum lipid concentrations.

Section snippets

Material and methods

Serum lipid concentrations of 47 patients with ATR who were admitted to Department of Orthopedics and Traumatology of Gülhane Military Medical Academy (GMMA), between May 1998 and June 2000 were examined. Six of these patients were female. The mean age of the whole group was 25.7 years. The control group consisted of 26 subjects comprised of 20 males and 6 females whose mean age was 32.6 years. Neither the patients nor control subjects had systemic problems with chronic or acute disease, which

Results

There were significant differences between ATR and control group in TC, LDL-C, HDL-C and TG values. Comparison of serum lipid concentrations of two groups is seen in Fig. 1. TC concentration was >5.18 mmol/l in 35 (74.5%) patients, TG concentration was >1.70 mmol/l in 18 (38.3%) patients, LDL-C concentration was >3.36 mmol/l in 33 (70.2%) patients. The concentration of HDL-C was not <0.91 mmol/l in any of the patients. All parameters, including cutoff levels, for ATR and control group, are

Discussion

ATR is easily diagnosed with history, physical exam, some diagnostic tests (e.g., Thompson test) and, in some doubtful situations, ultrasonographic examinations facilitate the diagnose [3], [6], [8], [14].

Revascularization problems and degenerative changes are believed to have an important role in the formation of ATR [7], [15]. Besides, it is claimed that some personal characteristics like blood groups (O and A) and serum uric acid concentrations might be risk factors [9]. In some studies

Acknowledgements

We thank Mark Ervin, M.D., F.S., Landstuhl Regional Medical Center, Germany, for reviewing the manuscript.

References (20)

  • S. Houshian et al.

    The epidemiology of Achilles tendon rupture in a Danish county

    Injury

    (1998)
  • M. Kuriyama et al.

    Cerebrotendinous xanthomatosis: clinical and biochemical evaluation of eight patients and review of the literature

    J. Neurol. Sci.

    (1991)
  • U.M. Kujala et al.

    ABO blood groups and musculoskeletal injuries

    Injury

    (1992)
  • N. Maffulli et al.

    Changing incidence of Achilles tendon rupture in Scotland: a 15-year study

    Clin. J. Sport Med.

    (1999)
  • T. Nyyssonen et al.

    Achilles tendon ruptures in southeast Finland between 1986–1996, with special reference to epidemiology, complications of surgery and hospital costs

    Ann. Chir. Gynaecol.

    (2000)
  • N. Popovic et al.

    Diagnosis and treatment of acute ruptures of the Achilles tendon. Current concepts review

    Acta Orthop. Belg.

    (1999)
  • P. Kannus et al.

    Etiology and pathophysiology of tendon ruptures in sports

    Scand. J. Med. Sci. Sports

    (1997)
  • N. Mafulli

    Current concepts review rupture of the Achilles tendon

    J. Bone Joint Surg. Am

    (1999)
  • M. Jarvinen et al.

    Histopathological findings in chronic tendon disorders

    Scand. J. Med. Sci. Sports

    (1997)
  • J. Leppilahti et al.

    ABO blood group and Achilles tendon rupture

    Ann. Chir. Gynaecol.

    (1996)
There are more references available in the full text version of this article.

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