Return to Play After Achilles Tendon Rupture
Achilles tendon (AT) ruptures are seen in both the weekend warrior and professional athlete. The prevalence in the general population is 8-18 per 100,000 people (1). The incidence of new cases is highest in patients aged 40 or greater (2). The Achilles tendon is compromised of the medial and lateral gastrocnemius muscle and the solues muscle (1). The AT is surrounded by the partenon, which is a sheath of connective tissue and tenocytes (1). The AT inserts on the posterior calcaneal tuberosity where it aids in plantarflexion (1).
Treatment of an Achilles tendon rupture can be surgical or non-surgical. Most high level athletes will choose surgical repair of the Achilles tendon, but there is no clear consensus (3,7). Previous data has shown that there is a rate of return to sports in elite athletes of 80% after rupture (3). However, in a study looking at return to play in NFL athletes, they only had a 61% to 73% rate of play following an AT rupture (3). This lower rate of return to play has also been identified in NBA players (4). Among NFL, NBA, and MLB players following an AT rupture, they all had reduced playing time one and two years after the rupture (4). The challenge when looking at return to play rates is that many studies do not have the same criteria for what is deemed a successful return to play. For example, some studies look at a return to unrestricted practice as a return to play, while some studies look at whether that athlete can return to the same professional level of play they were at prior to an injury.
Historically, surgically treated AT ruptures were found to have superior jump and muscular endurance compared to their nonsurgically treated counterparts (1). However, as nonoperative patients are treated with early weight bearing and functional physical therapy, some of these advantages appear to be diminishing (1).
The mean return to play for an Achilles tendon rupture based on a meta-analysis was 6 months (2). A study of professional soccer players found that the rate of re-rupture in a population of 71 athletes with a torn AT was 8% over the next two years after repair (6).
Achilles tendon ruptures have become more common as our population ages and patients become more active. Treatment can be surgical and nonsurgical. On average, 80% of high-level athletes can return to play. The average time to return to play is 6 months. There is a risk of re-tear following return to play, but it is typically less than 10%.
By Gregory Rubin, DO
1) Mansfield, Kirsten, et al. “Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play.” Current Reviews in Musculoskeletal Medicine, vol. 15, no. 5, Oct. 2022, pp. 353–61. PubMed, https://doi.org/10.1007/s12178-022-09774-3.
2) Zellers, Jennifer A., et al. “Return to Play Post-Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Rate and Measures of Return to Play.” British Journal of Sports Medicine, vol. 50, no. 21, Nov. 2016, pp. 1325–32. PubMed, https://doi.org/10.1136/bjsports-2016-096106.
3) LaPrade, Christopher M., et al. “Return-to-Play and Performance after Operative Treatment of Achilles Tendon Rupture in Elite Male Athletes: A Scoping Review.” British Journal of Sports Medicine, vol. 56, no. 9, May 2022, pp. 515–20. PubMed, https://doi.org/10.1136/bjsports-2021-104835.
4) Trofa, David P., et al. “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” The American Journal of Sports Medicine, vol. 45, no. 12, Oct. 2017, pp. 2864–71. PubMed, https://doi.org/10.1177/0363546517713001.
5) Grassi, Alberto, et al. “Epidemiology of Achilles Tendon Rupture in Italian First Division Football (Soccer) Players and Their Performance After Return to Play.” Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, vol. 32, no. 1, Jan. 2022, pp. e90–95. PubMed, https://doi.org/10.1097/JSM.0000000000000879.
6) Grassi, Alberto, et al. “Eighty-Two per Cent of Male Professional Football (Soccer) Players Return to Play at the Previous Level Two Seasons after Achilles Tendon Rupture Treated with Surgical Repair.” British Journal of Sports Medicine, vol. 54, no. 8, Apr. 2020, pp. 480–86. PubMed, https://doi.org/10.1136/bjsports-2019-100556.
7) Sanchez, Rafael, et al. “Effect of Achilles Tendon Repair on Performance Outcomes After Return to Play in National Collegiate Athletic Association Division I Basketball Athletes.” Orthopaedic Journal of Sports Medicine, vol. 9, no. 6, June 2021, p. 23259671211015240. PubMed, https://doi.org/10.1177/23259671211015239.
8) Giangarra, Charles E., and Robert C. Manske, editors. Clinical Orthopaedic Rehabilitation: A Team Approach. Fourth edition, Elsevier, 2018