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

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft

“…There is current literature favoring surgical management of Achilles tendon ruptures in high-level athletes because of a faster time to return to play and better functional outcomes 11 . Patients with large tendon gaps are associated with poorer function and less favorable patient-reported outcomes if managed nonoperatively 11 . Recent randomized controlled trials and comparative prospective studies comparing nonoperative and operative management either excluded patients with delayed presentations 10 or had patients with a smaller tendon gap than the patient in our report 12 .…”

“…Recent literature for acutely managed Achilles tendon rupture has focused on favoring nonoperative management, and in most cases, this results in positive patient-reported outcomes 10 . There is current literature favoring surgical management of Achilles tendon ruptures in high-level athletes because of a faster time to return to play and better functional outcomes 11 . Patients with large tendon gaps are associated with poorer function and less favorable patient-reported outcomes if managed nonoperatively 11 .…”

Postoperative Return to Play and the Role of Imaging

“…9 The Achilles tendon is the strongest, thickest tendon in the body, and it has the primary function of plantar flexion at the ankle. [35][36][37] The Achilles tendon's core is largely formed by 20 years of age, and it does not generally undergo renewal thereafter, with only the peripheral fibers capable of significant adaptation to respond to mechanical stress. 38 Although most tendons receive nutrients through a tendon sheath, the Achilles tendon instead relies on a paratenon to help provide blood flow and nourishment.…”

“…Explosive ankle action is common across a variety of sports, including running and jumping, and depends on the Achilles tendon, which can be subjected to forces up to 10 times the athlete's body weight with high-impact activities. 35 Despite the Achilles tendon having the greatest tensile strength in the human body, it is also one of the most common tendons to rupture, often during sport activities. 5,[38][39][40][41] Pathophysiology of Achilles tendon rupture is multifactorial, with increased risk associated with certain medications, such as fluoroquinolone antibiotics, corticosteroids, hormone replacement, and oral contraceptives, as well as peripheral vascular disease and inflammatory disorders.…”

“…36 The incidence of Achilles tendon rupture throughout the general population is between 8 and 50 per 100,000 persons, a number that will likely continue to rise with increased athletic participation and specialization. 5,35 Most tendon ruptures occur with sport activity, as high as 82%, often involving activities requiring episodic bursts of activity and stress, such as basketball, tennis, baseball, and American football. 6,42 Unfortunately, tendon rupture is almost always a season-ending surgery requiring an extended rehabilitation for the athlete, and it is potentially career threatening.…”