Achilles Tendon Rupture Incidence and Clinical Diagnosis

Mathijs bases the lecture on the Dutch multidisciplinary guideline on Achilles tendon ruptures from December 2023, drawn up by a multidisciplinary expert group from the literature, expert opinion and patient preferences. About 75 percent of patients are male, the average age is around 45, and the incidence is about 32 per 100,000 person-years, roughly double the rate of 20 years ago, with the rise mostly in people over 50. Ruptures peak in September when sports resume. Typical history: an acute snap, a feeling of being kicked from behind and immediate loss of calf function. No adequate studies support the Thompson test alone, but combining it with palpation of a gap and of reduced calf tone gave 100 percent sensitivity in one study. The guideline recommends the Thompson test and gap palpation within three days, with no imaging if both are positive, and ultrasound if history fits but a test is negative. Intact plantaris or flexor tendons can give false negatives. The ATRS tracks progress, though its minimal detectable change is large in the Danish and Dutch versions.