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Abstract
Introduction Achilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the military. The purpose of this retrospective cohort study was to evaluate the prevalence and associated factors of ATR in US military service members.
Methods The Defence Medical Epidemiology Database was used to identify all diagnosed ATR in military personnel from 2006 to 2015. The prevalence of ATR was calculated and compared by year, service branch and military rank. Unadjusted and adjusted assessments of risk were calculated.
Results Officers incurred 15 978 episodes at a prevalence of 7.43/1000 (male: 8.11/1000; female: 3.89/1000). Among enlisted personnel, there were 59 242 episodes of ATR that occurred at a prevalence of 6.23 episodes per 1000 (male enlisted: 6.49/1000; female enlisted: 4.48/1000). Apart from enlisted aviation specialists (where there was no significant difference in risk between men and women), both female officers and enlisted service members had significantly lower risk of ATR compared with their male counterparts in all occupations (prevalence ratio (PR): 0.26–0.73). Aviation and service officers demonstrated significantly lower risk of ATR episodes (PR: 0.87–0.91) and administration, operations, intelligence and logistic officers demonstrated increased risk (PR: 1.16–1.31) compared with ground and naval gunfire officers. Among enlisted specialties, all but mechanised/armour and combat engineers had significantly higher risk of ATR risk compared with infantry (PR: 1.14–2.13), with the highest risk observed in the administration, intelligence and communication fields.
Conclusions ATR was ubiquitous in the US military, with multiple risk factors identified, including male sex, older age, rank, military occupation and service branch. These findings highlight the populations that can most greatly benefit from preventive screening and care.
- SPORTS MEDICINE
- Foot & ankle
- Musculoskeletal disorders
- OCCUPATIONAL & INDUSTRIAL MEDICINE
- PUBLIC HEALTH
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
X @NavyPT
Contributors JJF contributed to the conception, study design, data acquisition and analysis. JJF, JAZ and CKS contributed to the drafting of this manuscript. All authors (JJF, JAZ, CKS and CFJ) contributed to data interpretation, critical revision and final approval of the study. JJF is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
.Disclaimer We affirm that we have no financial affiliation (including research funding) or involvement with any commercial organisation that has a direct financial interest in any matter included in this manuscript, except as disclosed and cited in the manuscript. Any other conflict of interest (ie, personal associations or involvement as a director, officer or expert witness) is also disclosed and cited in the manuscript
Competing interests JJF reports grants from Congressionally Directed Medical Research Programmes and the Office of Naval Research outside of the submitted work. In addition, JJF has a patent pending for an Adaptive and Variable Stiffness Ankle Brace, US Provisional Patent Application No. 63254,474. JJF, CKS and CFJ are military service members or employees of the US Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, U.S.C. §101 defines a US government work as work prepared by a military service member or employee of the US government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Navy, Department of Defense, Department of Veterans Affairs, or the US government. The study protocol was approved by the Naval Health Research Centre Institutional Review Board in compliance with all applicable federal regulations governing the protection of human subjects.
Provenance and peer review Not commissioned; externally peer reviewed.
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