Table 1.
A comprehensive table outlining the risk factors and regenerative medicine approaches for Achilles tendon ruptures, organized by modifiable and non-modifiable factors, along with their effects.
| Risk Factors | Modifiable/Non-Modifiable | Effect | References |
|---|---|---|---|
| Genetic Predisposition | Non-modifiable | Polymorphisms in genes encoding extracellular matrix proteins affect tendon fiber strength, predisposition to damage, injury severity, and recovery rate. | [[43], [44], [45]] |
| - G1023T gene (rs1800012) | Affects type I collagen synthesis; absence of TT genotype may be protective. | [43] | |
| - MMP3 gene (rs679620G, rs591058C, rs650108A) | Polymorphisms associated with Achilles tendovaginopathy; interaction with COL5A1 gene increases risk. | [44]. | |
| - TNC gene (9q33) | Polymorphisms in introns associated with high risk and protective markers for Achilles tendon rupture. | [45] | |
| Age-Sex Factor | Non-modifiable | Higher incidence in men due to greater muscle forces; age-related degenerative changes increase rupture risk. | [9,[46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61]] [[62], [63], [64], [65], [66], [67]]. |
| Anatomical Features | Non-modifiable | Structural variations in tendon attachment and fiber architecture influence rupture susceptibility. | [[68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80]] |
| Physical Activity (Sedentary Lifestyle) | Modifiable | Sudden physical activity after a sedentary period increases injury risk. | [46,54,[81], [82], [83], [84], [85], [86], [87]]. |
| Physical Activity (Professional Athletes) | Modifiable | Overtraining and improper training regimens elevate injury risk. | [46,47,[85], [86], [87], [88]]. |
| Comorbidities (Connective Tissue Dysplasia) | Modifiable | Structural abnormalities in connective tissues increase risk. | [89,90] |
| Comorbidities (Foot/Ankle Deformities) | Modifiable | Biomechanical disorders due to deformities predispose to chronic injuries. | [[89], [90], [91], [92], [93], [94], [95]]. |
| Metabolic Disorders (Obesity) | Modifiable | Excessive load on tendons causes pathological changes and reduces strength. | [45,[81], [82], [83]] |
| Metabolic Disorders (Type II Diabetes) | Modifiable | Structural changes and increased tendon thickness observed in diabetic patients. | [[84], [85], [86], [87], [88], [89], [90], [91]] |
| Metabolic Disorders (Hypercholesterolemia) | Modifiable | Cholesterol deposits cause chronic inflammation and tendon degeneration. | [[92], [93], [94], [95]] |
| Metabolic Disorders (Hyperuricemia) | Modifiable | Urate crystal deposition alters tendon structure, increasing rupture risk. | [[96], [97], [98], [99], [100], [101], [102]] |
| Thyroid Hormone Imbalance | Modifiable | Hormone imbalances impair collagen synthesis, increasing injury risk. | [62,82,[103], [104], [105], [106], [107], [108], [109]] |
| Drug-Induced Risk Factors | Modifiable | Certain medications increase the risk of tendinopathy and rupture through various mechanisms. | [[110], [111], [112], [113], [114], [115], [116], [117], [118], [119], [120], [121], [122], [123], [124], [125], [126]] |
| - Fluoroquinolones | Increase MMP expression and collagen degradation; inhibit tenocyte activity. | [[113], [114], [115], [116], [117], [118]] | |
| - Antimicrobial drugs | Linked to tendinopathy and rupture. | [[119], [120], [121]] | |
| - Statins | Weaken tendon structural components and activate apoptosis. | [111,112,122] | |
| - Corticosteroids | Inhibit tenocyte activity and collagen synthesis; increase collagen breakdown. | [111,112,123] | |
| - Aromatase Inhibitors | Decrease estrogen levels, leading to tendon fiber damage. | [[111], [112], [113],124] | |
| - Anabolic Steroids | Cause rapid muscle mass buildup and increased tendon load. | [111,112,125] | |
| - Isotretinoin | Linked to tendon damage. | [126] | |
| - Renin-Angiotensin System Drugs | Statistically associated with tendon rupture. | [119] | |
| - Thiazide Diuretics and Calcium Channel Blockers | Associated with tendinitis and painful ankle swelling. | [111,112,117] |