title: Predictors of primary Achilles tendon ruptures.
abstract: BACKGROUND
  The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing.
  
  
  OBJECTIVE
  The aim of this review was to systematically summarize predictors influencing Achilles tendon rupture (ATR) risk.
  
  
  METHODS
  A systematic literature search was performed of reported determinants influencing the ATR risk. Studies were eligible if there was: (i) description of determinants predicting ATR; (ii) an outcome defined as ATR; (iii) any study design with at least ten adults included with ATR; (iv) use of statistical tests regarding differences between patients with an ATR and healthy controls; (v) a full text article available; (vi) an article written in English, German or Dutch. Quality assessment was done using a standardized criteria set. Best-evidence synthesis was performed.
  
  
  RESULTS
  We included 31 studies, of which two (6.5%) were considered high-quality studies. Moderate evidence was found for increased ATR risk and decreased fibril size of Achilles tendon.
  
  
  CONCLUSIONS
  Based on the results of this systematic review there is moderate evidence that decreased tendon fibril size increases the ATR risk. There is limited evidence for many other factors, some of which are modifiable, such as increased body weight, oral corticosteroid use and quinolone use and living in an urban area, and therefore may be of interest in future studies. Furthermore, these results showed that more high-quality studies are needed for evaluating the determinants influencing the ATR risk.
authors.affiliation: Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Femke M A P
authors.initials: FM
authors.lastname: Claessen
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: de Vos
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
authors.forename: Duncan E
authors.initials: DE
authors.lastname: Meuffels
mesh_terms: D000125:Achilles Tendon / Q000033:anatomy & histology / Q000293:injuries* / Q000502:physiology; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000367:Age Factors; D048909:Diabetes Complications; D005528:Foot / Q000502:physiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications; D009765:Obesity / Q000150:complications; D011403:Pronation; D015363:Quinolones / Q000009:adverse effects; D051437:Renal Insufficiency / Q000150:complications; D012111:Residence Characteristics; D012307:Risk Factors; D012421:Rupture / Q000209:etiology; D012737:Sex Factors
chemical_list: D000305:Adrenal Cortex Hormones; D015363:Quinolones