title: Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study.
abstract: BACKGROUND
  Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers.
  
  
  OBJECTIVE
  Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non-AAS-using bodybuilders.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants.
  
  
  RESULTS
  Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P < .001). Several men reported 2 or more independent lifetime tendon ruptures. Interestingly, upper-body tendon ruptures occurred exclusively in the AAS group (15 [17%] AAS users vs 0 nonusers; risk difference, 0.17 [95% CI, 0.09-0.25]; P < .001 [hazard ratio not estimable]), whereas there was no significant difference between users and nonusers in risk for lower-body ruptures (6 [7%] AAS users, 3 [6%] nonusers; hazard ratio, 3.1 [95% CI, 0.7-13.8]; P = .13). Of 31 individual tendon ruptures assessed, only 6 (19%) occurred while weightlifting, with the majority occurring during other sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically, with complete or near-complete ultimate restoration of function.
  
  
  CONCLUSIONS
  AAS abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture.
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Gen
authors.initials: G
authors.lastname: Kanayama
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James
authors.initials: J
authors.lastname: DeLuca
authors.affiliation: Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Meehan
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Isaacs
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Baggish
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rory
authors.initials: R
authors.lastname: Weiner
authors.affiliation: Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lyle
authors.initials: L
authors.lastname: Micheli
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA hpope@mclean.harvard.edu.
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Pope
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage*; D000728:Androgens / Q000008:administration & dosage*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012421:Rupture / Q000139:chemically induced / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013708:Tendon Injuries / Q000139:chemically induced / Q000453:epidemiology*; D014891:Weight Lifting
chemical_list: D045930:Anabolic Agents; D000728:Androgens
keywords: anabolic-androgenic steroids; bodybuilding; men; tendon rupture; weightlifting