Compared to the general population, athletes in the National Football League (NFL) are at increased risk for injury because the game involves explosive acceleration and sudden changes in direction.3 Very little is known about the epidemiology of Achilles tendon ruptures in the NFL. Utilizing data publicly available on the Internet, one retrospective review identified 31 Achilles tendon ruptures in NFL players over a five-year period (5.2 injuries/year).3 During the 2008-2009 NFL season, six players suffered season-ending Achilles tendon ruptures. Although the incidence of Achilles rupture is low, 0.93% per NFL game, nearly 36% of affected players never return to playing at the NFL level.3
Parekh et al used a player’s power rating as a measure of functional outcome in the evaluation of “skill players” in the NFL, which included defensive tackles, cornerbacks, linebackers, wide receivers, and running backs.3 The power rating is a measure of a player’s performance using statistics gathered during game play, such as passing and rushing yards for an offensive player and tackles and interceptions for a defensive player. This study showed that 31 acute Achilles tendon ruptures occurred in NFL players between 1997 and 2002. The average age of a player sustaining a rupture was 29, with an average career before injury spanning six years.
Of the 31 players who sustained an Achilles tendon rupture, 21 (64%) returned to play in the NFL at an average of 11 months after injury. In the three seasons following their return, those 21 players saw significant decreases in games played and power ratings compared to the three seasons preceding the injury.
The percentage of players returning to play at the NFL level is consistent with a meta-analysis performed by Bhandari4 in 2002. The authors reported return to function rates of 63% for patients treated nonoperatively and 71% for those treated operatively. If we assume that all the NFL players were treated operatively, as would be the standard for young athletes, the return to play rate of 64% is slightly lower than the 71% reported in the meta-analysis. This difference could be attributed to the excessive demands placed on the operatively repaired Achilles tendon in NFL players combined with a body size, strength, and explosiveness that would further increase these demands.
The length of time to allow full activity after Achilles tendon repair is generally thought to be four to six months.4-6 The 11 months needed to return to play as a professional football player seems considerably longer. However, there is a major difference between allowing full activity and returning to play in the NFL. Even when the typical patient is allowed to participate in full activity, it does not mean that he or she is adequately rehabilitated to perform at maximal efforts. Studies to determine maximal improvement after surgical treatment are lacking in the orthopedic literature.
Furthermore, in the reviewed 21 NFL skill players who returned to play, there were significant decreases in games played per season (11.67 games per year pre-injury versus 6.17 games per year postinjury) when averaged over the three seasons before the injury and the three seasons after the injury.3 There were also decreases averaging nearly 50% in power ratings of the returning players for the three seasons after the injury compared to the three seasons before the injury. These data indicate that even in players able to return to their former level of play, the quality of play may suffer permanently.
