Environmental temperature and seasonal variations as risk factors for Achilles tendon rupture: a multi-center retrospective study in China.

Objectives: Achilles tendon rupture (ATR) is a common sports-related injury influenced by intrinsic and extrinsic factors. Environmental temperature and seasonal variations may play a role in ATR incidence, but their relationship remains underexplored. This study aimed to determine whether ambient temperature and seasonal changes are associated with the incidence of ATR. Methods: This retrospective study analyzed 379 ATR cases across three provinces in China-Hubei, Shandong, and Inner Mongolia-from October 2011 to June 2024. Temperature data were classified into five groups (-12.9 to -3.3 °C, -3.2 to 6.4 °C, 6.5-16.1 °C and 16.2-25.8 °C, 25.9-35.5 °C), and seasons were categorized into spring, summer, autumn, and winter. ATR incidence was assessed across these categories, with statistical significance evaluated using chi-squared and binomial tests. Results: ATR incidence was highest at temperatures 16.2-25.8 °C, a pattern that was observed consistently across Shandong and Inner Mongolia Provinces ( Conclusions: In this retrospective analysis of a three-province Chinese cohort, we observed that environmental temperature and seasonal variations were associated with ATR incidence, with the lowest rates at very low temperatures and higher incidence at mild-to-warm temperatures, particularly during springtime. These findings highlight the importance of validating these observations through larger, population-based studies.