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ACE-II receptor antagonists are associated with Achilles tendon rupture

In his doctoral thesis, Timo Nyyssönen, Lic Med, investigated the factors associated with Achilles tendon rupture.

Functional Achilles tendon is essential for normal gait. Tendon might rupture unexpectedly with only a minor ankle distension injury. However, sometimes there are predisposing symptoms such as local pain and swelling. The incidence of Achilles tendon rupture in industrialized countries has increased during recent decades. The reasons for this increase are largely unknown. The choice between operative and nonoperative treatment for acute Achilles tendon rupture is controversial. Operative treatment has been associated to better muscle strength but there is a high risk for local soft-tissue complications compared to nonoperative treatment.

The aim of this doctoral thesis was to investigate the epidemiology, to examine the results of the treatment, and to determine predisposing factors associating Achilles tendon rupture to medical drug treatments, if any.

The incidence of Achilles tendon rupture significantly increased especially in middle-aged and elderly patients between years 1987-1999. Major complications after Achilles tendon repair are rare. Tendon reconstruction reinforced with aponeurosis flap compared to simple tendon suturing has more local soft tissue related complications. Therefore, simple tendon suturing should be appropriate, at least in uncomplicated acute ruptures.

Several medical drug treatments, including fluoroquinolone antibiotics, are associated with Achilles tendon rupture. This thesis work showed a previously unreported, statistically significant association with renin-angiotensin II receptor antagonists.

The doctoral thesis of LL Timo Nyyssönen, Licentiate of Medicine, will be examined at the Faculty of Health Sciences, University of Eastern Finland, on 30 October 2020. The Opponent in the public examination will be Professor Juhana Leppilahti of the University of Oulu, and the Custos will be Professor Heikki Kröger of the University of Eastern Finland.

Public examination in Finnish

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