# Incidence rates of tendinopathies and non-traumatic tendon ruptures in Hong Kong: a 25-year epidemiological study using big data from public hospitals

## TL;DR

This study analyzed 25 years of Hong Kong hospital data to determine the incidence rates of tendinopathies and non-traumatic tendon ruptures, identifying key conditions and demographics for targeted prevention.

## Contribution

The study provides the first comprehensive 25-year epidemiological analysis of tendinopathies and non-traumatic tendon ruptures in Hong Kong using big data from public hospitals.

## Key findings

- The overall annual incidence rate for tendinopathies and non-traumatic tendon ruptures was 21.05 cases per 100,000 persons.
- Lateral epicondylitis had the highest incidence among tendinopathies, and rotator cuff rupture was most common among non-traumatic tendon ruptures.
- Older individuals (40–59) had higher rates of most tendinopathies, while males had higher rates of tendon ruptures.

## Abstract

Tendinopathy affects a substantial proportion of individuals and imposes a notable burden on healthcare systems. Its management poses considerable challenges, largely due to the limited availability of effective treatments, some of which may eventually lead to tendon tears. Despite its clinical importance, epidemiological research on tendinopathic conditions remains sparse and somewhat contentious. Consequently, there is an urgent need for comprehensive data to inform prevention strategies and optimize resource allocation. This study investigated the incidence of tendinopathy and non-traumatic tendon rupture in the Hong Kong population, using medical records from public hospitals. Data were sourced from the Clinical Data Analysis and Reporting System (CDARS). Patients with tendinopathy or non-traumatic tendon rupture were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) from 2000 to 2024. The overall, age-standardized, and sex-standardized annual incidence rates, as well as the age-specific and sex-specific annual incidence rates, were presented. Our study involved 36,970 patients across 47 public hospitals. The total annual incidence rate for the 17 tendinopathies and non-traumatic tendon ruptures included was 21.05 ± 7.08 cases per 100,000 persons. Incidence rate for the 10 tendinopathies was 15.48 ± 6.33, whereas for the 7 non-traumatic tendon ruptures was 5.57 ± 0.93. Tendinopathy had the highest overall incidence among cases of lateral epicondylitis, at 8.84 ± 3.31 cases per 100,000 persons, followed by Achilles tendinopathy at 3.09 ± 1.59. Regarding non-traumatic tendon rupture, rotator cuff tendon rupture had the highest average incidence at 1.90 ± 0.87 cases per 100,000 persons, followed by Achilles tendon rupture at 1.73 ± 0.37. Older individuals (aged 40–59) showed higher rates of most tendinopathies, except for patellar and Achilles tendinopathies predominantly affected in youngsters. Females had higher rates of several tendinopathies, while males had higher rates of patellar tendinopathy and various tendon ruptures. Our findings highlight several key tendon conditions for targeted prevention, with a focus on middle-aged adults and especially females for tendinopathies and males for non-traumatic tendon ruptures. Primary care providers are encouraged to facilitate earlier referrals for lateral epicondylitis and Achilles tendinopathy, while orthopaedic surgeons are advised to consider earlier interventions for these conditions. Additionally, emergency staff may consider additional training in the management of commonly encountered tendon conditions, such as rotator cuff tears and Achilles tendon ruptures.