Poster 394: The COVID Rebound Effect: Incidence of Tendon Rupture Surgeries in the Peri-Pandemic COVID Era

Objectives: The COVID-19 pandemic led to increased sedentary behavior and BMIs during 2020, which may decondition musculotendinous units and lead to increased risk for injury. Our hypothesis is as patients return to pre-COVID levels of activity, we hypothesize that there will be a resultant rebound increase in tendon ruptures. 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. 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 (Figure 1). When analyzed by quarter, linear regression model demonstrated a statistically significant increase in case counts over the period from Q2 2020 to Q2 2021 (β = 21.20; 95% CI = 13.62 - 28.78, p-value < 0.01). Conclusions: 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, health care providers, should counsel patients appropriately on return to activity or sport following long periods of induced inactivity. : This study presents important epidemiologic information on musculotendinous injury rates during the COVID-19 pandemic, that can help providers counsel patients when returning to their former baseline levels of physical activity.