Elsevier

Foot and Ankle Clinics

Volume 24, Issue 3, September 2019, Pages 439-445
Foot and Ankle Clinics

Maximizing Return to Sports After Achilles Tendon Rupture in Athletes

https://doi.org/10.1016/j.fcl.2019.04.003Get rights and content

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Key points

  • Achilles tendon ruptures are devastating injuries to the athlete with return-to-sport rates around 70% and some risk for diminished performance postinjury.

  • Surgical management is often favored for athletes, but evidence is limited in this population.

  • Functional rehabilitation protocols are critical regardless of operative or nonoperative management.

  • Return-to-play protocols are sparse and varied because of ambiguous definitions of return-to-sport criteria in the literature.

  • Optimal sport-specific

Operative versus nonoperative management in the athlete

Any discussion of ATR treatment has traditionally been framed by the balance between the risk of rerupture with nonoperative treatment on the one side versus the risk of wound issues with operative treatment on the other. In athletes, operative treatment is often favored because, given the long recovery with these injuries, a rerupture would be a disaster for an athlete. Although it could be reasonably argued that a wound complication would be no less a disaster, the reality is that most

Early functional rehabilitation

One aspect of treatment that seems to lower the rate of rerupture among patients with this injury without regard to whether the patient is treated operatively or nonoperatively is early functional rehabilitation. There are now reams of data showing that early weight-bearing and early functional rehabilitation leads to stronger new tendon formation and better ultimate functional outcomes.7, 8, 9, 10, 11 Many treatment protocols do not differentiate much between operative and nonoperative

Return to play protocols

Clearly, these injuries are significant ones that severely affect an athlete’s ability to function at a high level. However, the goal of surgeon and athlete alike is to try to minimize this impact. To that end, some authors have suggested optimal RTP protocols for these patients. Grävare Silbernagel and Crossley12 offered a starting point with their proposed program for RTP with noninsertional Achilles tendinopathy by codifying a protocol and a proposed progression. However, they did not

Performance following Achilles tendon rupture

Many authors have looked at the effect of an ATR on professional athletes in various sports. Parekh and colleagues21 assessed the epidemiology and outcomes of ATRs in the National Football League (NFL), retrospectively reviewing 31 ATRs over a 5-year period (1997–2002). In this cohort, only 68% of athletes were able to return to sport and those that did generally returned at a lower level of efficacy compared with preinjury. Another study used the NFL Orthopedic Surgery Outcomes Database

Summary

ATRs are devastating injuries for athletes that require a long recovery and may not allow athletes to achieve the heights of athletic ability that they had before the injury. The understanding of RTP in these injuries is in its infancy. Currently, there are no validated guidelines for returning an athlete to sport and the decision rests on clinical judgment and collaboration between the clinician, physical therapist, trainer, and the athlete. As the understanding of this injury and its

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  • Cited by (26)

    • Current Consensus for Rehabilitation Protocols of the Surgically Repaired Acute Mid-Substance Achilles Rupture: A Systematic Review and Recommendations From the “GAIT” Study Group

      2022, Journal of Foot and Ankle Surgery
      Citation Excerpt :

      They found considerable variability of the timing of strengthening, stretching and proprioception, and 52% recommended return to sports after certain criteria are met. Caldwell and Vosseller focused on RTS/RTP: protocols were sparse and varied, and milestones should be better defined (8). Criteria for RTS/RTP would be considered critical for athletes, especially since many professionals do not return fully (10,41) Protocols to optimize this would be helpful, even for the general population, and in several countries prospective research in this field is being undertaken (44).

    View all citing articles on Scopus

    Disclosure Statement. J.M. Caldwell: nothing to disclose. J.T. Vosseller: AAOS, board or committee member; American Orthopaedic Foot and Ankle Society, board or committee member; DJ Orthopaedics, paid consultant; Foot and Ankle Orthopaedics, editorial or governing board; New Clip Technics, IP royalties; Saunders/Mosby-Elsevier, publishing royalties, financial, or material support.

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