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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Fluoroquinolone Exposure and Other Factors Associated with Achilles Tendon Rupture: A Nationwide Nested Case–Control Study

  • Jae Yong Park1
  • Hye Chang Rhim2,3
  • Young-Min Kwon4
  • Jihyun Hwang5
  • Collin Lee6
  • Yagop Shin7
  • Sung Jae Kim7,8
8 affiliations
  1. 1Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
  2. 2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02115, USA
  3. 3Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA
  4. 4Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
  5. 5The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
  6. 6Department of Biology, University of Maryland–College Park, College Park, MD 20742, USA
  7. 7Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul 04763, Republic of Korea
  8. 8Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
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Abstract

Background/Objectives: Fluoroquinolones have been associated with tendon disorders, including Achilles tendon rupture (ATR). We investigated the associations of individual fluoroquinolone prescriptions and patient characteristics with ATR in a nationwide Korean claims dataset. Methods: This nested case–control study used Korean National Health Insurance Service data from 2009 to 2019. We included 40,240 ATR cases identified by KCD code S86.0 and 160,960 risk-set-sampled controls. Exposure was defined as a fluoroquinolone prescription lasting more than six days within 180 days before the index date. Poisson regression described population rates; unconditional multivariable logistic regression estimated adjusted odds ratios (aORs). Results: The overall incidence of ATR was 29.1 per 100,000 persons and increased during the study period. Levofloxacin prescriptions were associated with higher odds of ATR (aOR 1.28, 95% CI 1.13–1.44). In age-stratified analyses, the levofloxacin estimate was 1.08 (95% CI 0.82–1.41), 1.25 (1.07–1.46), and 1.66 (1.23–2.23) in those aged 23–39, 40–64, and ≥65 years, respectively; interaction was not formally tested. Higher BMI (30–34.9 kg/m2: aOR 2.20, 95% CI 2.09–2.32) and other patient characteristics were also associated with ATR in the overall sample. Conclusions: Levofloxacin exposure was associated with ATR, particularly in older adults, although outcome specificity, exposure classification, residual confounding, and incomplete accounting for matching limit causal interpretation. The data do not establish the comparative safety of other fluoroquinolones or fluoroquinolone-specific effects of patient characteristics.

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Cite

BibTeXRIS
BibTeX
@article{park2026fluoroquinolone,
  title = {{Fluoroquinolone Exposure and Other Factors Associated with Achilles Tendon Rupture: A Nationwide Nested Case–Control Study}},
  author = {Jae Yong Park and Hye Chang Rhim and Young-Min Kwon and Jihyun Hwang and Collin Lee and Yagop Shin and Sung Jae Kim},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218404},
  url = {https://www.mdpi.com/2077-0383/15/21/8404},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Fluoroquinolone Exposure and Other Factors Associated with Achilles Tendon Rupture: A Nationwide Nested Case–Control Study
AU  - Jae Yong Park
AU  - Hye Chang Rhim
AU  - Young-Min Kwon
AU  - Jihyun Hwang
AU  - Collin Lee
AU  - Yagop Shin
AU  - Sung Jae Kim
PY  - 2026
DA  - 2026/10/28
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218404
UR  - https://www.mdpi.com/2077-0383/15/21/8404
AB  - Background/Objectives: Fluoroquinolones have been associated with tendon disorders, including Achilles tendon rupture (ATR). We investigated the associations of individual fluoroquinolone prescriptions and patient characteristics with ATR in a nationwide Korean claims dataset. Methods: This nested case–control study used Korean National Health Insurance Service data from 2009 to 2019. We included 40,240 ATR cases identified by KCD code S86.0 and 160,960 risk-set-sampled controls. Exposure was defined as a fluoroquinolone prescription lasting more than six days within 180 days before the index date. Poisson regression described population rates; unconditional multivariable logistic regression estimated adjusted odds ratios (aORs). Results: The overall incidence of ATR was 29.1 per 100,000 persons and increased during the study period. Levofloxacin prescriptions were associated with higher odds of ATR (aOR 1.28, 95% CI 1.13–1.44). In age-stratified analyses, the levofloxacin estimate was 1.08 (95% CI 0.82–1.41), 1.25 (1.07–1.46), and 1.66 (1.23–2.23) in those aged 23–39, 40–64, and ≥65 years, respectively; interaction was not formally tested. Higher BMI (30–34.9 kg/m2: aOR 2.20, 95% CI 2.09–2.32) and other patient characteristics were also associated with ATR in the overall sample. Conclusions: Levofloxacin exposure was associated with ATR, particularly in older adults, although outcome specificity, exposure classification, residual confounding, and incomplete accounting for matching limit causal interpretation. The data do not establish the comparative safety of other fluoroquinolones or fluoroquinolone-specific effects of patient characteristics.
SN  - 2077-0383
ER  -