Summary

Our data shows significantly less lower extremity and upper extremity tendinous injuries in 2020 compared to 2019.

Abstract

Introduction

The COVID-19 pandemic led to decreased physical activity levels, increased sedentary behavior, and increased BMIs during 2020. As patients return to pre-COVID levels of activity, we hypothesize that there will be a resultant rebound increase in tendon ruptures and sought to investigate the epidemiology of tendon ruptures at a single academic institution.

Methods

The electronic medical record was queried for current procedural terminology codes for tendon ruptures (Achilles, patella, quadriceps, hamstring, distal biceps, triceps, and pectoralis major) from January 2017 to December 2021 at a single academic urban center. Data was reviewed to ensure only acute tendon rupture repairs were included. The years 2017 –2019 was used as a proxy for pre-COVID rates, 2020 as a proxy for the COVID quarantine, and 2021 as a proxy for “Post-COVID” activity. Univariate analysis was performed for comparative data and linear regression analysis was performed for changes over time.

Results

A total of 1879 patients (82.8% male, mean age 47.8 years) who sustained tendon injuries and underwent surgical repair were identified. There were 589 (31.3%) Achilles tendon repairs, 181 (9.6%) patella tendon repairs, 414 (22.0%) quadriceps tendon repairs, 100 (5.3%) hamstring tendon repairs, 397 (21.1%) distal biceps repairs, 105 (5.6%) triceps repairs, and 93 (4.9%) pectoralis tendon repairs. The total number of tendon injuries per year was: 2017 – 357 (19.0%), 2018 – 380 (20.2%), 2019 – 380 (20.2%), 2020 – 308 (16.4%), 2021 – 454 (24.2%). The rates in 2017, 2018, and 2019 were within 1% of each other, but there was a 3.8% decrease in rate of tendon injuries from 2019 to 2020, and a 7.8% increase in rate of tendon injuries from 2020 to 2021. When analyzed by quarter, linear regression model demonstrated a statistically significant increase in case counts over the period from Q2 2020 to Q2 2021 (ß = 21.20; 95% CI = 13.62 - 28.78, p-value = 0.003). 2019 and 2020 were compared with respect to lower extremity and upper extremity tendinous injuries, which were both significantly less in 2020 compared to 2019 (p = 0.013).

Conclusion

A “COVID rebound” of tendon rupture repairs in 2021 from a prolonged period of inactivity during 2020 occurred at a single academic center. As patients return to pre-COVID levels of activity that may be unsuitable to their deconditioned state, extra precautions should be taken, and health care providers, particularly in Sports Medicine, should counsel patients appropriately on return to activity or sport following long periods of induced inactivity.