2015 ISAKOS Biennial Congress Paper #0

Bacteria Are Unlikely Involved in the Pathological Changes Prior to Rupture of the Achilles Tendon. A Prospective Cross-Sectional Study Investigating for 16S rDNA in 20 Consecutive Ruptures

Allan Cramer, MD, PhD, København N, Danmark DENMARK
Claus Moser, MD, Prof, Copenhagen DENMARK
Blaine Gabriel Fritz, PhD, Copenhagen DENMARK
Per Hölmich, DMSc, Prof., Copenhagen DENMARK
Kristoffer W. Barfod, MD, PhD, Virum DENMARK
Sports Orthopedic Research Center – Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark , Copenhagen, DENMARK

FDA Status Not Applicable

Summary: Bacteria are unlikely involved in the pathological changes that occur in the Achilles tendon before a rupture.

Abstract:

Background

The source of the pathological changes that occur prior to an acute Achilles tendon rupture (ATR) is not fully understood. Bacterial DNA has previously been detected in samples from ruptured Achilles tendons, suggesting a pathogenic role of bacteria in ATR. The study aimed to investigate if DNA from bacteria was present in acutely ruptured Achilles tendons. It was hypothesized that 20-30% of the samples from the rupture site and no samples from healthy tissue would be positive for bacterial DNA.

Methods

Twenty consecutive patients scheduled for surgical repair of an acute Achilles tendon rupture were included. Tendon biopsies were taken from the rupture site and from the healthy tendon tissue proximal to the rupture as a control. Samples were blinded to the technician and analyzed by 16S rDNA PCR and Sanger sequencing to identify the bacterial species present. A McNemar’s test for paired proportions was performed to test for statistically significant differences in the number of samples positive for bacterial DNA between the ruptured and control regions of the Achilles tendon.

Results

One of the 20 patients (5%) had a positive sample with bacterial DNA from the ruptured part of the Achilles tendon. The same patient also had a positive, but with different DNA, control sample. Additionally, one patient had a positive control sample. There was no statistically significant difference in the number of bacterial-DNA positive samples between the ruptured and control regions of the Achilles tendon (p>=0.05). The bacteria found (Staphylococcus sp., Micrococcus sp., and Staphylococcus epidermidis) are normal commensal organisms on the human skin.

Conclusion

Bacterial DNA is infrequent in tissue from ruptured Achilles tendons and if identified, likely is a result of contamination. This suggests that bacteria are not involved in the pathological changes occurring prior to rupture of the Achilles tendon.