Achilles Injuries Research Articles

The Impact of Knee and Ankle Injuries on National Basketball Association Player Performance Post-injury.

Athletes in the National Basketball Association (NBA) are subjected to high levels of mechanical stress increasing their risk of injury. The purpose of this study was to see how certain lower extremity injuries affect in-game performance in relation to each NBA athlete's demographics. The hypothesis was that NBA players' post-injury performance would differ depending on their demographics and the type of injury sustained. Descriptive epidemiology study of NBA injury list designations from the 2010/2011 season to the 2018/2019 season. About 255 lower leg injuries that met the inclusion criteria were selected from the injury lists spanning from the 2010/2011 season to the 2018/2019 season. These included ligamentous knee injuries, knee sprains, knee strains, knee hyperextensions, patellar injuries, ankle injuries, and Achilles injuries. The change in performance was determined by comparing mean game scores before and after injury with single-tailed, heteroscedastic t-testing and 95% confidence intervals for mean values. An overall statistically significant decrease in mean game score from 9.82 to 8.75 was seen in all included players (p = 0.01). Only athletes taller than the mean height (199.85 cm; p = 0.01) and heavier than the mean weight (101.63 kg;p = 0.02) showed a significant decline in performance. Ankle and knee injuries both resulted in a significant loss in game score (p = 0.04), with ankle injuries resulting in a greater average decline (-1.76 post-injury) than knee injuries (-1.34 post-injury). These findings suggest that treatment regimens should reflect the type of injury and demographics of the specific NBA player injured. Further research is warranted to determine if treatment may be more efficacious when streamlined based on player size and injury type.

Flexor hallucis longus tendon transfer for Tendo Achillis reconstruction

Background: Tendo Achilles injuries are common in orthopaedic practice. Degenerative, Chronic and failed repaires requires some form of soft tissue sleeve augmentation like Flexor Hallucis longs (FHL), Peroneus Brevis (PB), Plantaris etc.. are used along with proximal Tendo Achilles advancement procedures lie V-Y plasty, musculo tendinous Recession or Turn Down Procedures. These advancement procedure leads to weakening of already compromised Tendon. So, wanted to evaluate functional outcome of FHL tendon Trans Tendinous Transfer without any Advancement procedures. Methods: 20 patients satisfying inclusion criteria underwent FHL Trans tendinous Transfer to Tendo Achilles which is secured with Interference screw into the prepared bone bed of calcaneum. Initially anterior slab in planter flexion was applied later converted to cast in neutral position which is removed at the end of 6 weeks and joint mobilization started. Results: Out of 20 patients,11 were male patients and 9 were females. Average age ranged from 22 to 65 years. 9 were chronic Tears,9 were Degenerative Tears and 2 were failed Repairs. Wound healing complications were seen in 4 cases, 1 with chronic tear, 1 with Degenerative Tear and Both Filed repairs, all of them healed eventually. ALL patients were assessed for AOFAS at 6th and 12thmonth. The mean AOFAS of each subgroup improved significantly from months 3 to 12 (Table). At the one-year follow-up, all patients achieved good functional outcome in terms of the AOFAS scoring system. Conclusions: Tendo Achilles is the common tendon injured in ankle region due to repetitive stress and degeneration. Degenerative, Chronic and failed repair injuries of Tendo Achilles requires some form of soft tissue augmentation for healing. Trans-Tendinous FHL tendon transfer for Tendo Achilles Reconstruction shows good results with minimal complications in these scenarios in non-Athletic Population.

Achilles Tendon Injuries in the Pediatric Population.

Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries. A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings. Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9). We found that older adolescents (≥14y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population. Level-IV.

FUNCTIONAL OUTCOME OF FLEXOR HALLUCIS LONGUS TRANSFER AUGMENTED WITH GASTROCNEMIOUS TURNDOWN FLAP IN THE RECONSTRUCTION OF CHRONIC ACHILLES TENDON RUPTURE

Introduction Chronic spontaneus rupture of Achilles tendon commonly occurs in middle aged and elderly person, which often goes undiagnosed or untreated for long duration, resulting in large gap in between two ruptured ends. Disrupted Tendo Achilles causes weakness in plantar exion of foot and abnormal gait. Surgical repair of the chronic rupture have poor result due to large gap in between ends. Different surgical procedures are described in the literature for Reconstruction of chronic Tendo Achilles injuries without any clear superior technique. Purpose of this study is assessment of functional outcome of Flexor Hallucis Longus transfer augmented by turn down Gastrocnemius ap in chronic Tendo achilles rupture. Methods This study Assessed functional outcome of Chronic achilles tendon rupture, reconstructed by Flexor Hallucis Longus transfer augmented by turndown gastrocnemius ap done at orthopaedics department, Bankura Sammilani medical college between november 2020 to october 2021. Patients were followed up for 12 months and then assessed clinically for range of movement , return to normal mobility , persistance of pain and complications . Functional outcome were assesed by American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score and Visual analogue Score (VAS). Observations Out of 8 patients, 6 had Excellent AOFAS score of 90 to 100, while 2 patient had a good score of 80 to 89. None had fair or poor score.None of the patients had wound breakdown, ankle stiffness, persistant nerve palsy or rerupture of the reconstructed tendon. Mean VAS score for pain at 12 month follow for 8 patients was 0, as none had any pain complain. None of the patient had any loss of ankle joint movement or stability, All patient resumed there normal day to day activity but none could restart recreational or sporting activity. Conclusions. Flexor Hallucis Longus transfer with turndown ap augmentation gives good to excellent outcome with minimal complication, if meticulous soft tissue handling and proper wound closure are done.

Bilateral Achilles Tendon Ruptures in the NFL

Category: Sports Introduction/Purpose: Achilles tendon ruptures (ATR) can have devastating results for athletes in the National Football League (NFL). Although NFL athletes who suffer an ATR are successfully treated with surgery and rehabilitation, this potentially career- ending injury has demonstrated a decrease in return to play, playing time, and performance for athletes. With a mean career length of 3.3 years for NFL athletes, the ATR injury and subsequent 9 to 11 month rehabilitation period could adversely limit the impact athletes make both individually and at the team level. Although previous research has examined the effects of a unilateral ATR in athletes, the purpose of this study was to determine the effects of bilateral ATRs on the health, productivity, and career longevity of NFL athletes. Methods: Publicly available online injury data for NFL athletes who sustained bilateral ATRs between the start of the 2007 season and the start of the 2021 season were queried using online news and sports analysis web sources. Inclusion criteria consisted of NFL athletes who sustained two independent, contralateral ATRs and exclusion criteria were NFL athletes who only sustained a single ATR or athletes who subsequently reinjured the same tendon. Specific dates for the first ATR (ATR1), return to play after ATR1, second ATR (ATR2), return to play after ATR2, as well as most recent game played were recorded. NFL preseason, regular season, and postseason (playoff, wild card, Pro Bowl, and Super Bowl) games were used to tabulate the total number of games missed or played. Descriptive and univariate statistics were performed. Results: When analyzing five NFL athletes with bilateral ATRs, mean BMI was 33.4+-4, an average of 5.8+-4 seasons were completed before ATR1, and three athletes currently play. There was a significant decrease in Pro Bowl nominations with each successive ATR (p=0.027). A significant difference was observed for mean age at tendon rupture when comparing ATR1 and ATR2 (27.8+-4 vs 30.4+-4 years, p<0.01). Rehabilitation periods after ATR1 and ATR2 (9.3+-2 vs.10.9+-2 months), as well as number of games missed during rehabilitation periods for ATR1 and ATR2 (9.8+-4 vs.12.8+-6) were not significantly different. The mean time period after returning from ATR2 was 22.0+-16 months, with a mean number of 39.3+-24 games played (Table 1). When analyzing performance metrics of four defensive NFL athletes, forced fumbles was the only defensive metric to demonstrate significant change across ATRs (p=0.02). Conclusion: This case series investigated NFL athletes who sustained bilateral ATRs, demonstrating a significant difference in age at the time of each rupture along with a decreasing trend in the number of Pro Bowl nominations following successive Achilles injuries. Upon analyzing defensive NFL athletes, forced fumbles was the only performance metric that significantly changed across successive Achilles injuries. This case series is the first study to review the effect of bilateral ATRs in NFL athlete performance and further research should be conducted to continue analyzing how these injuries affect the health, productivity, and career longevity of NFL athletes.

Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play.

Achilles tendon ruptures (ATR) are detrimental to sports performance, and optimal treatment strategy and guidelines on return to play (RTP) remain controversial. This current review investigates the recent literature surrounding nonoperative versus operative management of ATR, clinical outcomes, and operative techniques to allow the athlete a successful return to their respective sport. The Achilles tendon (AT) is crucial to the athlete, as it is essential for explosive activities such as running and jumping. Athletes that sustain an ATR play in fewer games and perform at a lower level of play compared to age-matched controls. Recent studies also theorize that ATRs occur due to elongation of the tendon with fatigue failure. Biomechanical studies have focused on comparing modes of fixation under dynamic loading to recreate this mechanism. ATRs can be career-ending injuries. Fortunately, the recent incorporation of early weight-bearing and functional rehabilitation programming for non-operative and operative patients alike proves to be beneficial. Especially for those treated nonoperatively, with the incorporation of functional rehabilitation, the risk of re-rupture among non-operative patients is beginning to approach the historical lower risk of re-rupture observed among patients treated operatively. Despite this progress in decreasing risk of re-rupture particularly among non-operative patients, operative managements are associated with unique benefits that may be of particular interest for athletes and active individuals. Recent studies demonstrate that operative intervention improves strength and functional outcomes with more efficacy compared to nonoperative management with rehabilitation. The current literature supports operative intervention in elite athletes to improve performance and shorten the duration to RTP. However, we acknowledge that surgical intervention does have inherent risks. Ultimately, most if not all young and/or high-level athletes with an ATR benefit from surgical repair, but it is crucial to take a stepwise algorithmic approach and consider other factors, which may lead towards nonoperative intervention. These factors include age, chronicity of injury, gap of ATR, social factors, and medical history amongst others in this review.

Achilles Tendon Tears in Adolescents and Young Adults

Background:Achilles tendon tears are rare in adolescents and young adults, and management of these injuries remains controversial.Hypothesis/Purpose:To describe long-term limitations and physical activity levels following full or partial Achilles tears in adolescents and young adults, and report rates of surgical management, complications, re-tears, and time to return to sports (RTS).Methods:We conducted a descriptive study of young patients (8-22 years old) who were treated for a partial or full Achilles tear at two pediatric hospitals between 2004-2018. Demographic, imaging, and treatment data were retrospectively collected. Patient reported outcomes were obtained including the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Tegner Activity Scale (TAS), and separate questions about reinjury and return to sport.Results:Of the 41 eligible patients with Achilles injuries, 25 (61%; mean age 18.9 years; 40% male) had a minimum one year of follow-up data and were further analyzed. Twenty-three patients (92%) underwent surgical repair. Twenty patients (80%) returned questionnaires at a median 6.3 years (IQR, 3.4 to 9.7 years), while the other 5 patients were followed for a median of 1.8 years (IQR, 1.1 to 2.5 years). Twenty-two (88%) injuries were full tears, 53% (10/19) with reported location occurring mid-tendon. Median ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (4-8). Median FAOS scores were excellent for symptoms (91), pain (100), ADL (100), and sports (98), and were good for QOL (88). The 6-month RTS probability was 47% (95% CI, 19-66%) and at 12 months was 95% (65-99%). The median time to RTS for partial tears was 5.6 months vs. 6.6 months for full tears (p=0.05). One surgical patient (4%) had a retear which required revision repair while 2 others needed additional surgery (1 - arthroscopy for ankle impingement, 1 - surgery for haglund’s deformity). In addition to the 3 surgical patients requiring re-operation, 8 patients experienced other complications (11/25 total complications, 44%), which included minor wound/scar complications (4), scar formation necessitating hydrodissection (1), Achilles tendonitis (2), and persistent pain following conservative treatment leading to surgical repair (1). Females were more likely to experience a complication (9/15, 60%) compared to males (2/10, 20%), but this difference was not statistically significant (p=0.10).Conclusion:Adolescents and young adults surgically treated for an Achilles injury reported satisfactory long-term outcomes.

Sural Nerve Injury in the Achilles Tendon Repair with Dresden Instruments: Anatomical Study

Category:Trauma; HindfootIntroduction/Purpose:The surgical reconstruction of the Achilles tendon has evolved in favor of the use of percutaneous techniques over the traditional approach with wide approaches to reduce the complications inherent to this procedure. These percutaneous techniques can present lesions of the sural nerve. The objective of this study is to evaluate the distance of this structure with respect to the instruments used in the Dresden technique.Methods:Dissections were made in 16 anatomical pieces (ankles) to which a reproduction of the complete Achilles lesion was previously made and reconstructed using the technique to be studied. After this, the distance of the instrument position with respect to the sural nerve was measured, as well as other relevant measures, and the presence or absence of nerve injury was evaluated.Results:None of the pieces there was lesion of the sural nerve neither by direct injury nor by entrapment, in addition, an approximate distance of 10mm of the nerve was found with respect to the entry site of the percutaneous needles as described by the technique. The location of the nerve was always external to the Crural Fascia. We demonstrate a safety area in which the instruments can be used without lesions of the sural nerve.Conclusion:The technique described by Amlang with the use of Dresden instruments has a low rate of cutaneous complications and infection compared to the traditional approach for this injury, we find that if the risk of presenting injury is performed properly of the sural nerve is low and its reproduction, for the repair of Achilles injuries, should be considered as the first option over traditional open management.

Patient perception of Achilles tendon rupture treatment

The optimal treatment of Achilles tendon ruptures (ATRs) is a subject of some debate amongst orthopedic surgeons. Many patients’ understanding of Achilles injuries is limited and may be more informed by popular culture than anything objective. We sought to assess patient perceptions of ATRs using a proprietary questionnaire and correlate that with demographic information and the health literacy of the patient. Patients presenting with an Achilles tendon injury were asked to fill out a demographic form, the Literacy in Musculoskeletal Problems (LiMP) survey, to assess musculoskeletal health literacy, and a 22-question survey on ATRs designed to assess patient knowledge and perception of ATRs. Seventy percent of patients responded that surgery with or without other modalities is the most appropriate treatment for ATRs, while only 20% of patients responded that nonoperative treatment is most appropriate. Perceptions of treatment were not associated with demographic data or LiMP scores and appear to be biased to some degree towards surgery. In a setting in which the optimal treatment has not been fully worked out by surgeons, it is difficult to tell what influence patient perceptions may have on treatment, although it is possible these patient perceptions may cause surgeons to be more surgically aggressive.

Relationship between Stature and Length of Tendo Achilles in Adult Male and Female of Bangladesh

Background: Tendo Achilles injuries are usually related to poor ankle flexibility and strength and to overuse. Morphology of tendo Achilles is an important tool for its assessment which can be done by measuring tendon thickness, cross-sectional area and length of tendon.
 Objective: The aim of the study was to correlate length of tendo Achilles with stature in several age groups of sedentary people as measured by ultrasonography.
 Materials and method: This cross sectional analytical type of study was conducted in the department of Anatomy, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2013 to June 2014. The present study was performed on 200 tendo Achilles of 100 people (50 male and 50 female) randomly selected from the patients who came to the Radiology department of Dhaka Medical College Hospital for ultrasonography of any region of their body other than leg.
 Results: In this study length of tendo Achilles was measured in both legs of adult people and was correlated with stature. Highly significant correlation was found between length of tendo Achilles with stature (p<0.001).
 Conclusion: The data of length of tendo Achilles obtained from the present study may provide valuable information in different aspects of medical science as a guide line for physiotherapists, radiologists, sports professionals and ortho-surgeons in early detection and monitoring of rehabilitation especially of professional athletes.
 Delta Med Col J. Jul 2019 7(2): 80-83

Epidemiology of Achilles Tendon Injuries in Collegiate Level Athletes in the United States

Category:Hindfoot, Sports, TraumaIntroduction/Purpose:Achilles tendon rupture is a potentially devastating injury particularly for National Collegiate Athletic Association (NCAA) athletes. Little has been studied regarding the incidence and implications of Achilles tendon ruptures in this patient population. Better characterization of the factors commonly found in athletes who rupture their Achilles may provide clues to aid in their prevention.Methods:Achilles injuries across 16 sports among NCAA men and women during the 2004-05 to 2013-14 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Achilles tendon rupture rates per 100,000 athlete-exposures (IR), operative rate, annual injury rate trends, re-injury rates, mechanism of injury, in-season status (pre/in/post-season) and time loss distributions were compiled and calculated. A sub-analysis of contact sports and sports played by both genders (C-BG) was performed to determine if there were significant differences in risks in patients who played in contact sports.Results:N=255 Achilles tendon injuries were identified over 10 academic years (IR: 2.17). The injury rate was higher in males compared to females (IR=2.33 vs. 1.89 respectively). Achilles injuries were most common in Men’s Basketball (IR=4.26), Soccer (IR=3.06), and Football (IR=2.69). The top three women’s sports with Achilles injury were Gymnastics (IR=16.73), Basketball (IR=3.32), and Soccer (IR=1.81). Thirty-three injuries were operative (13.1%) and 14.9% (N=38) were season-ending injuries. The average time loss was 10.65 days when excluding patients who had season/career ending injuries. Reinjury rate was 11.0% (N=28). 61.2% of all injuries occurred during the regular season (N=156) with 36.0% (N=92) and 2.7% (N=7) occurring in pre- and post- season, respectively. There was a significantly greater number of injuries in contact (N=198) versus non-contact sports (N=50) (p<0.001).Conclusion:Achilles tendon ruptures can be devastating injuries in professional and collegiate athletes. In our study, nearly 15% of all NCAA Achilles tendon ruptures resulted in season ending injuries or significant time loss and over 13% of injuries required operative management with a majority of injuries occurring during practice. In addition, a significantly higher proportion of athletes who played a contact sport had Achilles injuries. Better understanding of what circumstances more often tend to result in Achilles injuries can help establish prevention strategies.

Patient Perceptions of Achilles Tendon Rupture

Category: Sports Introduction/Purpose: The optimal treatment of Achilles tendon ruptures (ATRs) is a subject of some debate amongst orthopaedic surgeons. However, patient perceptions of ATRs are unclear. Many patients understanding of Achilles injuries is limited and may be more informed by popular culture than anything objective. Many patients may assume that an ATR necessitates surgical treatment or that surgical treatment is “better” because that is how professional athletes are often treated. These ideas may be related to a patient’s health literacy. We sought to assess patient perceptions of ATRs using a proprietary questionnaire and correlate that with health literacy and the education level of the patient. Methods: Patients presenting to an academic orthopaedic foot and ankle clinic with a complaint of Achilles tendon injury were asked to fill out a demographic form, the LiMP (Literacy in Musculoskeletal Problems) survey to assess musculoskeletal health literacy, and a 22 question survey on ATRs designed to assess patients knowledge and perception of ATRs that was modelled after a similar survey done for meniscal injuries. Results: Twenty-nine patients were surveyed with a mean age of 45 years. 62% of respondents noted that they had little knowledge of the Achilles, with the remaining 38% saying that their knowledge of the Achilles was moderate to considerable. 14% of those surveyed were employed in healthcare. The mean LiMP score was 4.91 (out of 9, mean in general population in another study was 4.68). 70% of patients replied that surgery alone or in combination with physical therapy was the most appropriate treatment for an ATR. Only 11% of patients responded that physical therapy with some immobilization was sufficient. Conclusion: Patient perception of ATR treatment appears to be biased to some degree towards surgery. In an educated patient group that scored well in terms of health literacy, a majority of patients felt that surgical treatment was most appropriate. In a setting in which the optimal treatment has not been fully worked out by surgeons, it is difficult to tell what influence patient perceptions may have on treatment, although it is possible these patient perceptions may cause surgeons to be more surgically aggressive.

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

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.

Professional Athletes’ Return to Play and Performance after Achilles Tendon Ruptures

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 &lt; 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 &lt; 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 &lt; 0.001). Compared to controls, athletes with Achilles injuries played fewer games (p &lt; 0.001) and had decreased longevity (p=0.025), and performance statistics (p &lt; 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.

Achilles tendon injuries.

The purpose of this study is to review the current literature of Achilles tendon injuries, specifically chronic tendinopathy and acute ruptures in regard to etiology, diagnosis, treatment options, and outcomes. The incidence of Achilles tendon injuries is increasing, but the necessity for surgical intervention is decreasing due to improved conservative therapies, which may provide comparable outcomes without the implied surgical risk. If surgery is undertaken, no difference has been noted between open and minimally invasive techniques. The majority of patients are able to return to pre-injury level of activity, with the elite athlete as an unfortunate exception. Achilles injuries can be devastating injuries, but if addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality implemented. Further research is needed into the etiology, potential preventative measures, and longer-term outcomes of the different treatment options for wide range of Achilles pathology.

Factors Influencing Running-Related Musculoskeletal Injury Risk Among U.S. Military Recruits.

Running-related musculoskeletal injuries among U.S. military recruits negatively impact military readiness. Low aerobic fitness, prior injury, and weekly running distance are known risk factors. Physical fitness screening and remedial physical training (or discharging the most poorly fit recruits) before entry-level military training have tended to reduce injury rates while decreasing attrition, training, and medical costs. Incorporating anaerobic running sessions into training programs can offset decreased weekly running distance and decrease injury risk. Varying lower extremity loading patterns, stride length or cadence manipulation, and hip stability/strengthening programming may further decrease injury risk. No footstrike pattern is ideal for all runners; transitioning to forefoot striking may reduce risk for hip, knee, or tibial injuries, but increase risk for calf, Achilles, foot or ankle injuries. Minimal evidence associates running surfaces with injury risk. Footwear interventions should focus on proper fit and comfort; the evidence does not support running shoe prescription per foot type to reduce injury risk among recruits. Primary injury mitigation efforts should focus on physical fitness screening, remedial physical training (or discharge for unfit recruits), and continued inclusion of anaerobic running sessions to offset decreased weekly running distance.

Venous thromboembolism rates in patients with lower limb immobilization after Achilles tendon injury are unchanged after the introduction of prophylactic aspirin: audit

ESSENTIALS: We audited venous thromboembolism (VTE) in Achilles injuries after the use of prophylactic aspirin. We audited 218 patients with Achilles injury requiring lower limb immobilization for ≥ 1 week. Fourteen patients (6.4%, 95% CI 3.6% to 10.5%) developed symptomatic and confirmed VTE. The incidence was similar to the 6.3% identified in the same patient group prior to the use of aspirin. We report a follow-up audit of the incidence of venous thromboembolism (VTE) in patients requiring lower limb immobilization because of Achilles tendon injury, since the introduction of a policy to routinely prescribe 100 mg of aspirin daily. We studied 218 patients aged 18-65 years who attended the Orthopaedic Assessment Unit at Wellington Hospital between January 2013 and December 2014 with Achilles tendon injury requiring lower limb immobilization for ≥ 1 week. Information on assessment of VTE risk, prescription of aspirin and symptomatic VTE occurring within 70 days of immobilization was obtained and compared with the same information collected with the same method in the same patient group between January 2006 and December 2007, before the policy to routinely prescribe aspirin was introduced. A total of 189 of 218 (93%) patients were prescribed aspirin, as compared with 0.5% previously. Fourteen patients (6.4%, 95% confidence interval 3.6-10.5%) developed symptomatic radiologically confirmed VTE (10 distal deep vein thromboses [DVTs], two proximal DVTs, one pulmonary embolism [PE], and one PE with distal DVT). Aspirin was prescribed to all patients who subsequently developed a VTE; in one of 14, a recognized risk factor was documented. The VTE incidence was similar to the 6.3% identified in the previous audit. Lower limb immobilization following Achilles tendon injury confers a high risk of VTE even with aspirin prophylaxis. Consideration should be given to prophylaxis with low molecular weight heparin during lower limb immobilization following Achilles tendon injury, as this has proven efficacy in this clinical situation.

Achilles Injuries in the Athlete: Noninsertional

Achilles tendinopathy is common in both athletic and nonathletic individuals, and the incidence has risen in the last few decades. Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its cause, pathology, natural history, and optimal management. The treatment of Achilles tendinopathy lacks evidence-based support, and individuals having tendinopathy are at risk of long-term morbidity with unpredictable clinical outcome. Most patients respond to conservative treatments. When conservative management is unsuccessful, surgery is recommended. Similar results have been reported with both open and minimally invasive techniques. However, minimally invasive techniques appear to reduce the risks of infection and provide better cosmetic results. An Achilles tendon rupture is frequent in young athletes and middle-aged people who practice recreational activities, and it is a serious injury. The management should take into account the age, occupation, and level of sporting activity. Open surgery provides good functional results and a lower rerupture rate, but it is frequently associated with a higher risk of superficial skin breakdown and wound problems. Percutaneous repair aims to provide good functional outcome while decreasing the problems associated with open surgery for wound healing and skin breakdown. Percutaneous repair followed by early functional rehabilitation is becoming increasingly common and should be considered in selected patients.

Comparison of injury incidences between football teams playing in different climatic regions

Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999–2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01–1.10) with quadriceps strains (RR 1.32, 95% CI 1.10–1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16–1.74), and ankle sprains (RR 1.17, 95% CI 1.00–1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47–1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.

Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics

Plantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article, the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games.