scholarly journals Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Selene Parekh ◽  
Jay Shah

Category: Ankle, Sports Introduction/Purpose: While much less common than ankle sprains and other sports injuries, Achilles tendon ruptures have represented unexpected and potentially career-altering injuries for professional football athletes in the National Football League (NFL). Over the past decade, the technique for surgical repair of the ruptured Achilles tendon has evolved. Mini-open and percutaneous techniques have become more common, allowing for the minimization of wound complications and expediting the rehabilitation of athletes. Therefore, the objectives of this study were to update the epidemiology of Achilles tendon ruptures in the NFL, and to analyze how recovery and post-injury performance of professional football players with this injury have progressed in the last two decades. Methods: Several online sources including NFL news and injury reports, player registries, and player statistic databases were cross-referenced to conduct a retrospective identification of all NFL players sustaining complete Achilles tendon ruptures during the 2010-2015 NFL seasons. Yearly player performance statistics were also obtained and recorded for both offensive and defensive players. A power rating formula and “approximate value” algorithm, commonly used to evaluate player production, were borrowed to calculate yearly Offensive and Defensive performance metrics for each injured player. These calculated measurements were used to quantify both offensive and defensive player performance up to 3 seasons before and after their respective Achilles tendon rupture injuries, allowing for each player to serve as his own control. Results: 78 Achilles tendon ruptures were identified in professional football players during the 2010-2015 NFL seasons. 58% of these injuries occurred during the preseason. Of those that suffered an Achilles tendon rupture, 26% did not ever return to play in the NFL. Players who did return to play in the NFL took an average of 9 months to recover after the date of injury. Across all positions, there was a net decrease in power ratings by 22% and a net decrease in approximate value by 23% over 3 years following player return after Achilles tendon rupture. Across all positions, running backs saw the biggest decrease in production with a 78% decrease over 3 years post-injury in both power ratings and approximate value. Conclusion: While the incidence of Achilles tendon ruptures in NFL players, especially in the preseason, has increased substantially, more players are returning to play after injury and with better post-injury performance as compared to the previous two decades. These injuries should still be considered potentially career-altering as 26% of players never return to play after Achilles tendon ruptures and there is still a net decrease in power-ratings by 22% for those who do return. However, these numbers optimistically suggest that advancements in treatment protocol and rehabilitation are resulting in faster recovery and improved performance after Achilles tendon ruptures in NFL players.

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Johnathan Miller ◽  
Denzel Woode ◽  
Eugene Jang ◽  
David Trofa ◽  
Justin Greisberg ◽  
...  

Category: Sports Introduction/Purpose: The majority of Achilles tendon ruptures are sports-related. A significant decrease in return to play, playing time, and performance has been shown in National Basketball Association (NBA) players who sustained a complete Achilles tendon rupture requiring surgical repair. However, no study to date has examined and compared the impact on performance and return to play across multiple professional sports. Methods: Publicly available records yielded a list of NBA, National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who suffered Achilles tendon ruptures requiring surgical repair from 1989-2013. Demographic information and performance-related statistics were recorded from public sports statistics websites. The primary outcome of this study was the proportion of games played post- vs. pre-injury. Secondary markers of longevity were minutes played for NBA, games started for NFL, and innings played in field for MLB. Inclusion criteria included individuals in the NBA, NFL, MLB, and NHL with professional experience for at least 2 years before and after sustaining a primary Achilles tendon rupture requiring surgical repair. A matched control was selected for all returning players by identifying athletes with similar playing position, number of seasons played, and career performance statistics. The study was powered to detect a 15% difference in games played between ruptures and controls. Results: Of 100 athletes initially screened for the study, 43 met the inclusion criteria. Others were excluded for not completing at least 2 seasons pre- (n=16) or post-injury (n=32), or having a confounding injury (n=9). Athletes on average played 75.4% (p < 0.001) and 81.9% (p=0.002) of the games played the season prior to injury at 1 and 2 years post-injury, respectively. Other markers of longevity were also significantly decreased in athletes at 1 and 2 years post-injury (p < 0.001). Athletes also performed worse, with post-injury performances equivalent to 74.8% of pre-injury performance at 1 year (p=0.001) and 77.7% at 2 years (p < 0.001). Compared to controls, athletes with Achilles injuries played fewer games (p < 0.001) and had decreased longevity (p=0.025), and performance statistics (p < 0.001) at 1 year, but not 2 years after injury. Conclusion: An Achilles rupture is a devastating injury with many athletes unable to return to play. Further, athletes who managed to play for 2 years after injury play significantly fewer games, and experience significant decreases in secondary measures of longevity and performance metrics. Compared to controls, however, only the 1-year post-injury longevity and performance statistics were significantly worse. This implies a bimodal distribution of successful return to play: a significant portion of athletes undergoing repair never return to their prior level of competition, but those that do can often perform at a level commensurate with non-injured controls after 2 years.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Vincent Federico ◽  
Samy Gabriel ◽  
Christopher W. Reb

Category: Sports; Trauma Introduction/Purpose: For the professional athlete, an Achilles tendon rupture is a devastating and potentially career ending injury. Basketball players with Achilles tendon injuries have among the lowest reported return to play rates for orthopaedic injuries. Among National Basketball Association (NBA) players, Achilles rupture has been shown to result in difficulty with returning to competition and significantly decreased productivity exhibiting a large effect size (0.95). Comparable data regarding Women’s National Basketball Association (WNBA) players is lacking. This study evaluated the impact of Achilles tendon rupture on return to play and post-injury performance among WNBA players in order to test the null hypothesis of equal negative impact as observed in the NBA. Methods: This was an IRB exempt retrospective matched cohort study. Public records indicated 12 WNBA players incurred Achilles tendon ruptures between the 2006 and 2018 seasons. Demographic data and performance statistics were collected for pre and post-injury seasons. A control cohort was matched for age, height, weight, years of experience in WNBA, position, and pre-injury player efficiency rating (PER). Individual pre versus post injury and injury cohort versus control cohort performance statistics were compared using paired and independent samples t-tests, respectively. Injury effect size on performance was calculated. The primary outcome was difference in PER. Secondary outcomes included differences in itemized performance statistics. A priori sample size based on effect size of 0.95 indicated that 12 players per cohort were needed for 80% power to detect a difference in PER at alpha of 0.05. Results: 7 (58%) players returned to WNBA play by mean 9.5 months. There was no significant difference in pre injury PER from seasons matched for years of WNBA experience between cohorts (13.7 vs 11.9; P = 0.6). Mean PER significantly decreased in the first year (13.66 vs 9.00; P = .04; Cohen’s d = .99) and approached a significance difference in the second year (14.56 vs 9.95; P = 05; Cohen’s d = 1.02) in the injured cohort only. Minutes per game (MPG) significantly decreased only year 1 post-injury (25.84 vs 19.54; P = .04; Cohen’s d = 6.56). Points per game (PPG), field goals attempted per game (FGA), and free throws attempted per game (FTA) significantly decreased in both years post-injury (all p < 0.05). Conclusion:: WNBA players incurred Achilles tendon ruptures at a rate of 2% annually. This was associated with a moderate rate of return to play and significantly reduced production (PER, MPG, PPG, FGA, and FTA) in the first year. The second season following injury found players returning closer to pre-injury performance, with persistent significant reduction in PPG, FGA, and FTA. Effect sizes were uniformly large. These data were consistent with NBA results, supporting the null hypothesis. Providers may use this data to counsel high and elite level female basketball players on return to play and performance expectations following Achilles tendon ruptures.


2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198998
Author(s):  
Joseph S. Tramer ◽  
Lafi S. Khalil ◽  
Patrick Buckley ◽  
Alexander Ziedas ◽  
Patricia A. Kolowich ◽  
...  

Background:Women’s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR).Purpose:To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes.Study Design:Cohort study; Level of evidence, 3.Methods:WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups.Results:Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (±SD) of 12.5 ± 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 ± 6.9 fewer games, starting in 12.7 ± 15.4 fewer games, and playing 10.2 ± 9.1 fewer minutes per game ( P < .05 for all). After the index date of injury, the players with Achilles repair played 2.1 ± 1.2 more years in the WNBA, while control players played 5.35 ± 3.2 years ( P < .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 ± 5.3 vs 11.0 ± 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls ( P < .05 for both).Conclusion:The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls.


2021 ◽  
pp. 193864002110403
Author(s):  
Dane Barton ◽  
Aditya Manoharan ◽  
Ansab Khwaja ◽  
Jacob Sorenson ◽  
Michel Taylor

Background: The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players. Methods: The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair. Results: RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game ( P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group. Conclusion: A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture. Levels of Evidence: Analytic, level 3, retrospective cohort study, Epidemiologic study


2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110241
Author(s):  
Enrico M. Forlenza ◽  
Ophelie Z. Lavoie-Gagne ◽  
Yining Lu ◽  
Connor C. Diaz ◽  
Jorge Chahla ◽  
...  

Background: Achilles tendon rupture (ATR) is a potentially career-ending injury in professional athletes. Limited information exists regarding return to play (RTP) in professional soccer players after this injury. Purpose: To determine the RTP rate and time in professional soccer players after ATR and to evaluate player performance relative to matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 132 professional soccer players who suffered an ATR between 1999 and 2018. These athletes were matched 2:1 to uninjured controls by position, age, season of injury, seasons played, and height. We collected information on the date of injury, the date of RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) from official team websites, public injury reports, and press releases. Changes in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate comparisons were performed using independent-sample, 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results: The mean age at ATR was 27.49 ± 4.06 years, and the mean time to RTP was 5.07 ± 2.61 months (18.19 ± 10.96 games). The RTP rate was 71% for the season after injury and 78% for return at any timepoint. Overall, 9% of the injured players experienced a rerupture during the study period. Compared with controls, the injured players played significantly less (-6.77 vs -1.81 games [ P < .001] and -560.17 vs -171.17 minutes [ P < .05]) and recorded fewer goals (-1.06 vs -0.29 [ P < .05]) and assists (-0.76 vs -0.02 [ P < .05]) during the season of their Achilles rupture. With the exception of midfielders, there were no significant differences in play time or performance metrics between injured and uninjured players at any postinjury timepoint. Conclusion: Soccer players who suffered an ATR had a 78% RTP rate, with a mean RTP time of 5 months. Injured players played less and demonstrated inferior performance during the season of injury. With the exception of midfielders, players displayed no significant differences in play time or performance during any of the 4 postinjury seasons.


2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096604
Author(s):  
Lafi S. Khalil ◽  
Toufic R. Jildeh ◽  
Joseph S. Tramer ◽  
Muhammad J. Abbas ◽  
Luke Hessburg ◽  
...  

Background: National Basketball Association (NBA) players who return to sport (RTS) after Achilles tendon rupture have been reported to have poor outcomes. Purpose: To evaluate the effect of Achilles tendon ruptures on player performance and career longevity in NBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: NBA players who sustained Achilles tendon ruptures between 1970 and 2019 were identified using publicly available resources and were matched 1:1 to a healthy control group by age, position, height, and body mass index. Demographic characteristics, player utilization (games and minutes), and performance efficiency rating (PER) were documented for all athletes. The season of Achilles tendon rupture was set as the index year, and statistical analysis compared postindex versus preindex data both acutely and in the long term. Percentages relative to preoperative values were calculated to compare the injured and control groups in a standardized fashion. Results: Of 47 players, 34 (72.3%) with Achilles tendon ruptures returned to play at the NBA level after surgical intervention. A total of 7 players were excluded from the study. No differences were found in demographic characteristics or PER (2 years before injury) between the remaining 27 players and matched controls. The injured players had significantly shorter careers compared with control players (3.1 ± 2.3 vs 5.8 ± 3.5 seasons, respectively; P < .05). Injured players demonstrated significant declines in games per season (GPS), minutes per game (MPG), and PER at 1 year and 3 years after RTS compared with preindex baseline ( P < .05). Injured players, compared with control players, had reduced relative percentages of games started (GS) (50% vs 125%, respectively), MPG (83% vs 103%), and PER (80% vs 96%) at 1 year after return ( P < .05), but reductions at extended 3-year follow-up were seen only in GPS (71% vs 91%) and GS (39% vs 99%) ( P < .05). Conclusion: Our study found that 72.3% of NBA players returned to play after Achilles tendon repair, but they had shorter careers compared with uninjured controls. Players returning from Achilles tendon repairs had decreased game utilization and performance at all time points relative to their individual preindex baseline. However, for the injured players when compared with controls, game utilization but not performance was found to be decreased at 3-year follow-up.


Author(s):  
Elizabeth C. Heintz ◽  
Emily F. Foret ◽  
Jeremy J. Foreman

Background: Sports-related concussion (SRC) rates are higher in American football than any other sport; therefore, the effects of SRCs on professional football players is a prevalent topic. Previous research has shown that sustaining an SRC has negative financial and overall career outcomes for athletes and may cause performance decrements after an athlete returns to play, however, the results of previous research regarding athlete performance after returning from an SRC are mixed. While some studies found that player performance in the National Football League (NFL) was unaffected upon returning from an SRC, evidence also suggests significant scoring reductions in offensive players. Although previous research has found that NFL running backs and wide receivers perform at levels similar to their performance before sustaining an SRC, little is known about quarterback performance after an SRC. There is also evidence that SRCs decrease neurocognitive performance, a quality that is crucial, especially for quarterbacks. Objective: The purpose of this study is to examine changes in NFL quarterback performances upon return to play from an SRC. Method: Quarterback ratings (QBRs) and concussion data from 2012-2015 were used to determine if changes occurred in NFL quarterback performance following an SRC. Results: QBRs decreased by 13.3 points (p = 0.014) after quarterbacks return from an SRC. Conclusions: Changes in on-field performance for NFL quarterbacks after sustaining an SRC could be the result of neurocognitive decrements that impact quick reaction and decision-making skills, which may have greater impacts on quarterbacks than other positions.


2019 ◽  
Vol 47 (11) ◽  
pp. 2717-2722 ◽  
Author(s):  
Toufic R. Jildeh ◽  
Kelechi R. Okoroha ◽  
Kevin A. Taylor ◽  
Patrick Buckley ◽  
Samir Mehta ◽  
...  

Background: Concussion injuries are common in professional football players; however, their effect on player performance remains unclear. Purpose: To quantify the effect of concussions on the performance of running backs and wide receivers in professional football players. Study Design: Cohort study; Level of evidence, 3. Methods: Concussion data from the National Football League were collected for a period of 4 seasons (2012-2015) for running backs and wide receivers. Age, experience, position, time to return to play, yearly total yards, and touchdowns were recorded. A power rating (total yards divided by 10 plus touchdowns multiplied by 6) was calculated for each player’s injury season as well as for the 3 seasons before and after their respective injury. A control group of running backs and wide receivers without an identified concussion injury who competed in the 2012 season was assembled for comparison. Player performance up to 3 seasons before and after the injury season was examined to assess acute and longitudinal changes in player performance. Results: A total of 38 eligible running backs and wide receivers sustained a concussion during the study period. Thirty-four (89%) players were able to return to competition in the same season, missing an average of 1.5 ± 0.9 games; the remaining 4 players returned in the subsequent season. Power ratings for concussed players were similar to those of controls throughout the study period. Concussed players did not suffer an individual performance decline upon returning within the same season. Furthermore, no significant difference in change of power rating was observed in concussed players in the acute (±1 year from injury; −1.2 ± 4.8 vs –1.1 ± 3.9, P = .199) or chronic (±3 years from injury; –3.6 ± 8.0 vs –3.0 ± 4.5, P = .219) setting compared with controls. All concussed players successfully returned to competition in either the index or next season. Conclusion: A high rate of National Football League running backs and wide receivers are able to return to play after a concussion injury. These players were found to perform at a similar level in both the acute and long-term period after concussion.


2017 ◽  
Vol 45 (12) ◽  
pp. 2864-2871 ◽  
Author(s):  
David P. Trofa ◽  
J. Chance Miller ◽  
Eugene S. Jang ◽  
Denzel R. Woode ◽  
Justin K. Greisberg ◽  
...  

Background: Most Achilles tendon ruptures are sports related. However, few studies have examined and compared the effect of surgical repair for complete ruptures on return to play (RTP), play time, and performance across multiple sports. Purpose: To examine RTP and performance among professional athletes after Achilles tendon repair and compare pre- versus postoperative functional outcomes of professional athletes from different major leagues in the United States. Study Design: Cohort study; Level of evidence, 3. Methods: National Basketball Association (NBA), National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2013 were identified via public injury reports and press releases. Demographic information and performance-related statistics were recorded for 2 seasons before and after surgery and compared with matched controls. Statistical analyses were used to assess differences in recorded metrics. Results: Of 86 athletes screened, 62 met inclusion criteria including 25 NBA, 32 NFL, and 5 MLB players. Nineteen (30.6%) professional athletes with an isolated Achilles tendon rupture treated surgically were unable to return to play. Among athletes who successfully returned to play, game participation averaged 75.4% ( P < .001) and 81.9% ( P = .002) of the total games played the season before injury at 1 and 2 years postoperatively, respectively. Play time was significantly decreased and athletes performed significantly worse compared with preoperative levels at 1 and 2 years after injury ( P < .001). When players were compared with matched controls, an Achilles tendon rupture resulted in fewer games played ( P < .001), decreased play time ( P = .025), and worse performance statistics ( P < .001) at 1 year but not 2 years postoperatively ( P > .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance. Conclusion: An Achilles tendon rupture is a devastating injury that prevents RTP for 30.6% of professional players. Athletes who do return play in fewer games, have less play time, and perform at a lower level than their preinjury status. However, these functional deficits are seen only at 1 year after surgery compared with matched controls, such that players who return to play can expect to perform at a level commensurate with uninjured controls 2 years postoperatively.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Murphy ◽  
C Hurson

Abstract Background The COVID19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions pertaining to sports saw a sudden return to play for many people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. In our institution, we appeared to have a large number of these injuries within a short space of time. We hypothesised that Phase 3 of “Lockdown”, where all sports were allowed to return, led to increased Achilles tendon rupture rates vs. the same period in 2019 due to a prolonged period of inactivity. Method Data from electronic theatre logbooks of all operations performed in the trauma theatre from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected. Results 772 cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 of these occurred after Phase 3. 555 cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2%). 11 of these occurred after Phase 3. Conclusions Overall, there was a greater number and greater rate of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. 8 of the 11 occurring after Phase 3 in 2020 occurred in the month of July. This led the authors to believe they were occurring more frequently. In conclusion, the COVID19 pandemic restrictions and subsequent return to play after inactivity does not increase the rate of Achilles tendon rupture.


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