Poster 190: Adolescent Achilles Tendon Ruptures in the United States: An Evaluation of National Practice Patterns, Management Trends, Complications and 2-year Failure Rates

Objectives: Achilles tendon ruptures, though relatively uncommon in the adolescent population, present significant clinical challenges due to the unique biomechanical and physiological characteristics of developing tissues. While the management of Achilles tendon ruptures in adults is well documented, the optimal treatment strategy for adolescents remains unclear, with a lack of large-scale studies focusing on this population. The purpose of this study was to analyze trends in the incidence and management of adolescent Achilles tendon ruptures in the United States and to compare short-term complication rates and long-term outcomes between operative and nonoperative approaches. Methods: This retrospective cohort study utilized a large national administrative claims database (PearlDiver) to identify adolescent patients (ages 0-19) diagnosed with Achilles tendon ruptures from 2010 to 2022 using International Classification of Diseases codes. Patients were classified based on rupture type (open vs. closed) and management strategy (operative vs. nonoperative). Trends in the incidence of Achilles tendon ruptures and the distribution of management strategies over the study period were assessed. A subset of patients with a minimum of 2 years follow-up was analyzed for complications following rupture management. Outcomes evaluated were 90-day complication rates, 2-year ankle fracture rates, and the incidence of failed management, defined as the need for subsequent surgical intervention within two years. Statistical analyses included Student t-tests, chi-square tests, and linear regression analyses, with significance set at p<0.05. Results: A total of 23,458 adolescent patients with Achilles tendon ruptures were identified, with 88.6% in the 10-19 age group and 50.4% being female. Most ruptures were closed (99%) and managed nonoperatively (96.1%). Nonoperative treatment was more common in closed compared to open ruptures (96.5% vs. 64.7%, p<0.001). Among those treated operatively, most underwent repair (93.1%) rather than reconstruction (6.9%). From 2010 to 2022, the incidence of Achilles tendon ruptures increased significantly across all age groups (p<0.05). The percentage of patients treated operatively decreased (p < 0.001) during this time (Figure 2). Operative management was associated with greater 90-day complication rates, including infections (3.9% vs. 0.43%, p<0.001), nerve injuries (0.30% vs. 0.03%, p=0.016), and wound complications (1.2% vs. 0.07%, p<0.001), and a higher two-year failure rate (5.2% vs. 0.19%, p<0.001). These trends continued when just closed injuries were assessed, but no significant differences were observed between operative and nonoperative management in open ruptures (Table 2). Conclusions: The incidence of adolescent Achilles tendon ruptures has increased significantly over the past decade. There was also a trend towards nonoperative management, particularly for closed ruptures during this time. Nonoperative management is associated with lower complication and failure rates compared to operative treatment. Continued monitoring and further research are essential to define optimal treatment strategies and ensure optimal outcomes for adolescent patients with Achilles tendon ruptures.