Page 134 - 《运动与健康科学》(英文)2024年第2期

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Journal of Sport and Health Science 13 (2024) 256263

Original article
TaggedAPTARAH1Epidemiology of insertional and midportion Achilles tendinopathy in

runners: A prospective cohort studyTaggedAPTARAEnd
b
TaggedAPTARAPWenbo Chen a,b,c, *, Kyra L.A. Cloosterman , Sita M.A. Bierma-Zeinstra a,b ,
b a
Marienke van Middelkoop , Robert-Jan de Vos TaggedAPTARAEnd
a
TaggedAPTARAP Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
b
Department of General Practice, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
c
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
TaggedAPTARAEnd Received 11 October 2022; revised 5 February 2023; accepted 24 February 2023
Available online 23 March 2023
2095-2546/Ó 2024 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license.
(http://creativecommons.org/licenses/by-nc-nd/4.0/)

TaggedAPTARAPAbstract
Background: Achilles tendinopathy (AT) is a common problem among runners. There is only limited evidence for risk factors for AT, and most
studies have not defined the AT subcategories. No study has compared the incidence and risk factors between insertional AT and midportion
AT, though they are considered distinct. This study aimed to assess incidence and risk factors of AT based on data from a large prospective
cohort. The secondary aim was to explore differences in risk factors between insertional and midportion AT.
Methods: Participants were recruited from among registered runners at registration for running events. Questionnaires were completed at base-
line, 1 month before the event, 1 week before the event, and 1 month after the event. Information concerning demographics, training load, regis-
tered events, and running-related injuries were collected at baseline. The follow-up questionnaires collected information about new injuries. A
pain map was used to diagnose midportion and insertional AT. The primary outcome was the incidence of AT. Multivariable logistic regression
analysis was applied to identify risk factors for the onset.
Results: We included 3379 participants with a mean follow-up of 20.4 weeks. The incidence of AT was 4.2%. The proportion of insertional AT
was 27.7% and of midportion AT was 63.8%; the remaining proportion was a combined type of insertional and midportion AT. Men had a signif-
icantly higher incidence (5%, 95% confidence interval (95%CI): 4.1%6.0%) than women (2.8%, 95%CI: 2.0%3.8%). AT in the past
12 months was the most predominant risk factor for new-onset AT (odds ratio (OR) = 6.47, 95%CI: 4.27 9.81). This was similar for both subca-
tegories of AT (insertional: OR = 5.45, 95%CI: 2.5111.81; midportion: OR = 6.96, 95%CI: 4.2411.40). Participants registering for an event
with a distance of 10/10.55 km were less likely to develop a new-onset AT (OR = 0.59, 95%CI: 0.360.97) or midportion AT (OR = 0.47,
95%CI: 0.23 0.93). Higher age had a significant negative association with insertional AT (OR = 0.97, 95%CI: 0.941.00).
Conclusion: The incidence of new-onset AT among recreational runners was 4.2%. The proportion of insertional and midportion AT was 27.7%
and 63.8%, respectively. AT in the past 12 months was the predominant risk factor for the onset of AT. Risk factors varied between insertional
and midportion AT, but we could not identify clinically relevant differences between the 2 subtypes.

TaggedAPTARAPKeywords: Achilles tendon injury; Incidence; Risk factor; Running-related injuryTaggedAPTARAEnd

4
general population. It is more common in endurance runners
TaggedAPTARAH11. IntroductionTaggedAPTARAEnd
4
with a cumulative lifetime incidence of 52%. In addition to
TaggedAPTARAPAchilles tendinopathy (AT) is a tendon disorder with the
triad of pain, swelling, and impaired performance. 1,2 AT can the high incidence, there is a substantial negative impact of
AT on quality of life, work productivity, and total costs
be subclassified into insertional AT and midportion AT, which
(approximately EUR840 per conservatively treated AT patient
are regarded as separate entities with different etiology and 5
3 annually). A substantial proportion (25%60%) of AT
treatment options. AT has a lifetime incidence of 6% in the 2,6
patients experience symptoms for 510 years. Given its
longstanding nature, AT is a substantial healthcare problem in
TaggedAPTARAEnd Peer review under responsibility of Shanghai University of Sport. the middle-aged working population.TaggedAPTARAEnd
TaggedAPTARAEnd* Corresponding author. TaggedAPTARAPAccording to the Translating Research into Injury Preven-
E-mail address: w.chen@erasmusmc.nl (W. Chen). tion Practice framework, identifying risk factors through
https://doi.org/10.1016/j.jshs.2023.03.007
Cite this article: Chen W, Cloosterman KLA, Bierma-Zeinstra SMA, van Middelkoop M, de Vos R-J. Epidemiology of insertional and midportion Achilles tendin-
opathy in runners: A prospective cohort study. J Sport Health Sci 2024;13:25663.