Achilles Tendon Injuries in the NFL

[DaveRoberts'Shoes]

http://central.sonsofsamhorn.net/nfl/new-england-patriots/achilles-tendon-injuries-in-the-nfl/

 

[Deathofthebambino]

I made a post regarding this in the off-season when it appeared he wouldn't be back with the Patriots. There have been some rather large studies on Achilles injuries in the NFL and the likelihood of a player returning and what they will do when they get back.  See below:
 
 

I'm happy with the Revis signing. I'm a big, giant 'meh' on Wilfork. Probably one of my favorite players of all time, but I will be surprised if he plays more than 10 games this season. A big, giant man (there is no way in hell he is only 320 pounds, he's closer to 400 than he is 300) coming off a major Achilles injury? I'm betting against 99% of the time. I'll root for him anywhere he goes, but when I heard the news yesterday, I was sad that he's leaving, but no part of me was worried about it being a bad decision, and the Pats have about 1,000x more information than I have about what to expect from him this year. If they somehow work something out, which I doubt, I'll be happy to see him in a Pats uniform and I'll hope like hell that he plays like his incredible self and finishes his awesome career here, but it wouldn't surprise me at all to see us struggling again next year while he is down with an injury.
 And don't take my word for it either, there is actually research to support this. Of the 31 players that suffered Achilles injuries over a 5 year period, only 21 actually returned to play (an average of 11 months later). That's 36% that never played again. Of the 21 that came back, they averaged 5 less games per year over their next 3 years and a 50% average drop in power ratings across the board. Check out this very, lengthy article on the topic:
http://lowerextremityreview.com/article/return-to-football-after-achilles-tendon-rupture
 

 
 

 

[soxfan121]

Dr. Awesome is probably in surgery or something right now but this week's installment of "DRS educates football fans" is a must-read. 
 
Please, share this piece on facebook, twitter or print it out and put it in your dorm room bathroom. No $10 co-pay owed, so long as you spread the word about Football Central and Dr. Awesome. 

 

[Deathofthebambino]

Just to be clear, I didn't mean that to come across in any off handed way.  Looks like you cited the same study, DRS. 

 

[theapportioner]

I performed a quick and dirty literature search on rates of return of NFL players after repair of various musculoskeletal injuries. Basically, small sample sizes and many other sampling caveats, but it seems the rate of return for players after an Achilles rupture is on the lower end of the spectrum compared to others.
 
Injury type/surgery                                           Proportion that returned to play
 
Achilles tendon rupture                                    68% (21 of 31)
ACL repair (2010)                                             63% (31 of 49)
ACL repair, quarterbacks only (2014)              92% (12 of 13) (14 knees)
ACL repair (2006)                                             77% (24 of 31) (33 knees)
    ACL repair (aggregate)                                      72% (67 of 93)
Patellar tendon repair                                       79% (19 of 24) (some with concomitant ACL repair)
Lateral meniscectomy                                      61% (47 of 77)
Proximal hamstring repair                                100% (10 of 10)
Distal quadriceps repair                                   50% (7 of 14)
Shoulder stabilization                                       90% (54 of 60)
Cervical disc herniation                                    72% if operative treatment (38 of 53), 46% if nonoperative (21 of 46)
Lumbar disc herniation                                     81% if operative treatment (42 of 52), 29% if nonoperative (4 of 14)
 
 
References:
 
http://www.ncbi.nlm.nih.gov/pubmed/20400426
http://www.ncbi.nlm.nih.gov/pubmed/21813442
http://www.ncbi.nlm.nih.gov/pubmed/20610771
http://www.ncbi.nlm.nih.gov/pubmed/16870822
http://www.ncbi.nlm.nih.gov/pubmed/25102509
http://www.ncbi.nlm.nih.gov/pubmed/24914032
http://www.ncbi.nlm.nih.gov/pubmed/23805425
http://www.ncbi.nlm.nih.gov/pubmed/23735426
http://www.amjorthopedics.com/topics/shoulder-and-elbow/article/return-to-play-rates-are-high-for-nfl-players-following-shoulder-stabilization-surgery/1671c1485b4f04db5d07591594090980.html
http://www.ncbi.nlm.nih.gov/pubmed/21084659
http://www.ncbi.nlm.nih.gov/pubmed/21220543
http://www.ncbi.nlm.nih.gov/pubmed/20714275

 

[SeoulSoxFan]

Doc, this is fantastic! 
 
I also am befuddled by high-ankle sprains. It seems like one of those lisfranc types where athletes try too soon to come back from (see Gronk, Dee Milliner) and just never get healed properly until a lot of rest. 

 

[theapportioner]

I also am befuddled by high-ankle sprains. It seems like one of those lisfranc types where athletes try too soon to come back from (see Gronk, Dee Milliner) and just never get healed properly until a lot of rest. 

 
I'm sure DRS will have a more accurate and sophisticated answer, but my sense is that because high ankle sprains are often initially treated non-operatively, there will be a percentage that fail non-operative treatment and then will have to go for more rehabilitation or surgery. Whereas, ACL tears and other injuries are almost always treated with surgery.

 

[Super Nomario]

I performed a quick and dirty literature search on rates of return of NFL players after repair of various musculoskeletal injuries. Basically, small sample sizes and many other sampling caveats, but it seems the rate of return for players after an Achilles rupture is on the lower end of the spectrum compared to others.
 
Injury type/surgery                                           Proportion that returned to play
 
Achilles tendon rupture                                    68% (21 of 31)

Anecdotally, it seems like recent cases have been more successful. Terrell Suggs and Michael Crabtree both tore their Achilles in the offseason but didn't even miss the whole year. Jason Peters ruptured his twice in the same offseason but returned to play 16 games last year. Wilfork was a full participant in offseason stuff after less than a full year. Crabtree's pretty young but Suggs, Peters, and Wilfork aren't. Kobe Bryant's a recent non-football example? Is this a procedure where improvements have been made in the last five years or so? Or is my memory selective here?

 

[theapportioner]

Well, assuming that the average career length for NFL players who make an opening day roster is 6.0 years (reference), that would make for an average annual attrition rate of 17%. Assuming that the cohort of players who have suffered Achilles ruptures is a subset of the above group, then the relative increased risk of not returning at all from an Achilles rupture is 32/17 = 1.9. 
 
So, with numerous caveats, the relative increased risk that an Achilles injury ends an NFL player's career is approximately 2x greater than the normal attrition rate for an NFL player. High, but not insurmountable, especially if there are no subsequent complications and the player played at a high level prior to his injury.
 
http://nflcommunications.com/2011/04/18/what-is-average-nfl-player%E2%80%99s-career-length-longer-than-you-might-think-commissioner-goodell-says/

 

[Super Nomario]

Well, assuming that the average career length for NFL players who make an opening day roster is 6.0 years (reference), that would make for an average annual attrition rate of 17%. Assuming that the cohort of players who have suffered Achilles ruptures is a subset of the above group, then the relative increased risk of not returning at all from an Achilles rupture is 32/17 = 1.9. 
 
So, with numerous caveats, the relative increased risk that an Achilles injury ends an NFL player's career is approximately 2x greater than the normal attrition rate for an NFL player. High, but not insurmountable, especially if there are no subsequent complications and the player played at a high level prior to his injury.
 
http://nflcommunications.com/2011/04/18/what-is-average-nfl-player%E2%80%99s-career-length-longer-than-you-might-think-commissioner-goodell-says/

Is there a risk factor involved with age here? Four of the five examples I named are towards the older side, and all the 2014 injuries Chris mentioned in the article are to players 30 or over. If the injury disproportionately affects older players, the aggregate numbers might overstate the risk of not coming back (since the affected group might be towards the end of their careers anyway).

 

[theapportioner]

I don't know the answer to your specific question -- for some reason I am unable to access the full article from the hospital/university network. But there may be survivorship biases in both directions: 1) players who are older are more likely to have had very successful careers, and quite possibly would continue to do so had the injury not occurred, but 2), the increased playing time over the years increases the overall likelihood that the player would sustain a serious injury during that career. On top of that, I would think that the incidence rate of injury also likely increases with age, just because body tissues start breaking down after all that abuse. Older people are more prone to hip fractures, etc. It wouldn't surprise me that this holds true for Achilles injuries also, that's just my guess.
 
Edit: numerous online references state that Achilles ruptures tend to happen in men over the age of 30. 

 

[neil]

Great article. In it you say:
 

The tendon usually ruptures in a non-contact injury, most often when the foot is forcibly planted with most or all of the athlete’s weight applied to that leg

 
But is there any idea why this occurs? Seems like most players are doing a very repetitive action? Is it a case that the rupture occurs due to that repetition or just because that one time the load suddenly went through the roof through body mechanics or whatever.