2025 ISAKOS Biennial Congress Paper
Low Rates of Return to Play and Reduced Levels of Performance in Athletes Participating in the National Football League Following Acute Achilles Tendon Ruptures: A Systematic Review
James J Butler, MB BCh, New York, New York UNITED STATES
Davis Hedbany, BS, Syracuse, NY UNITED STATES
Luilly Vargas, MD, New York, New York UNITED STATES
Matthew T Kingery, MD, New York, NY UNITED STATES
Charles C Lin, MD, New York, New York UNITED STATES
Sebastian Krebsbach, BS, New York UNITED STATES
John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS (Orth), New York UNITED STATES
NYU Langone Health, New York, NY, UNITED STATES
FDA Status Not Applicable
Summary
NFL athletes with acute Achilles tendon ruptures have a 66.2% return-to-play rate and experience significant declines in both game participation and performance, highlighting the severe impact of such injuries on their careers.
Abstract
Introduction
The purpose of this systematic review was to evaluate rates of return to play and levels of performance following acute Achilles tendon ruptures (AATR) in the National Football League (NFL). Additionally, we sought to determine the prevalence rates of AATR and identify any risk factors for the development of AATR.
Methods
During May 2024, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following treatment of acute Achilles tendon ruptures (AATR) in the NFL. Twelve studies were included.
Results
In total, 676 players (698 Achilles) sustained an AATR in the NFL. The playing positions that sustained the highest rates of AATRs was linebackers (19.0%), wide receivers (11.9%) and running backs (9.0%). 139 AATRs (50.4%) occurred in the preseason, 135 AATRs (48.9%) occurred during the regular season and 2 AATRs (0.7%) occurred during a post-season game. Playing surface was not associated with an increased risk of AATR. The return to play rate was 66.2% at a weighted mean time of 10.9±1.3 months. The mean number of games played per season following AATR was 12.9 games and the weighted mean career length following AATR was 2.2 ± 0.8 seasons. Overall, player performance deteriorated significantly following AATR, as demonstrated by lower power rankings and position specific metrics.
Discussion And Conclusion
This systematic review found was that the proportion of athletes participating in the NFL who returned to play following AATR was 66.2%. Both the mean number of games played per season and the mean number of seasons played decreased significantly following AATR. Overall, player performance deteriorated following AATR, regardless of player position. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.