Return to Play After Mini-Open Repair of Achilles Tendon Ruptures in the NFL Athlete

Abstract

Category: Sports Introduction/Purpose: Non-insertional Achilles tendon ruptures are a devastating injury in the National Football League (NFL) athlete. Depending on timing, these often are season ending injuries. There are mixed reports in the literature regarding impact of Achilles injuries in elite athletes. Additionally, there have been advancements in techniques including a mini-open repair that has proven successful. The purpose of this study was to critically analyze a large, single surgeon series of non-insertional Achilles ruptures in NFL athletes treated with a mini-open technique. Our primary focus was to determine return to play and evaluate possible contributing factors that affect this. Additionally, we sought to compare pre and post injury performance for those who successfully returned to the NFL. Methods: NFL athletes treated for non-insertional Achilles ruptures since 2012 were included. Demographic and performance data were obtained from the NFL.com player database and included position, age, years in the league, return to sport and relevant performance metrics listed below. Pre injury frequency of play (games played per total games in season) for athletes were recorded. The impact of injury on performance after return to sport was assessed by comparing data from two years prior and two years post injury, normalized to a “per game” basis. For defensive players, specific metrics included tackles, pass deflection, interceptions and sacks. For offensive players, rushing and receiving statistics for running backs and wide receivers/tight ends were recorded, respectively. Average yards per run/catch, attempts per game, number of 20+ yard plays and touchdowns were recorded. Data was analyzed with Welch’s method 2-Sample t test in Minitab. Results: Thirty-five ruptures were identified in predominantly defensive players (25/35). Ruptures occurred, on average, at age 27.7 years with 4.1 years of NFL experience. There was no significant difference in offensive (70%) and defensive (76%) player’s ability to return to the NFL (p=1.0). The frequency of play in the two seasons prior to injury differed significantly for players who did not return (21%) compared to those who did (95%) (p=.0013). Due to limited skill-position offensive players, further sub- analysis was limited. Defensive players who returned demonstrated significant differences in performance pre-injury compared to players who failed to return. In the two years following injury, returning defensive players performed at near baseline compared to pre injury statistics (figure 1). Conclusion: Achilles injuries occurred predominately in defensive players. Typically occurring past the average NFL career length, it represents a mid to late career injury. The comeback rate of 74% is excellent and is higher than previously reported. Those who failed to return were utilized less frequently pre-injury and had poorer performance statistics (defensive), indicating less talented players were impacted to a greater extent. Lastly, given limited or no differences found in productivity for those who returned, we conclude that while an Achilles injury is most often season ending, most skilled players are able to return with little impact on performance.