Factors Affecting Return to Play After Primary Achilles Tendon Tear: A Cohort of NFL Players

Abstract

Background: Achilles tendon tears are potentially career-ending injuries for professional athletes. For players in the National Football League (NFL), return requires not only surgery and extensive rehabilitation but also the ability to compete in a market with limited positions that annually introduces new recruits.

Purpose/hypothesis: We authors sought to evaluate factors related to return to play (RTP) and changes in performance following a primary Achilles tear. Our hypothesis was that "skilled" position players and those drafted in later rounds would return at a lower rate as compared with "unskilled" position players and higher draft-round players.

Study design: Case-control study; Level of evidence, 3.

Methods: From a previously established database, 80 NFL players were identified as having primary Achilles tendon tears between the 2009 and 2014 seasons. RTP was defined as playing in a regular season or postseason game following injury. Probability of RTP was modeled as a function of time after injury in Kaplan-Meier analysis with demographic variables assessed via generalized linear models. Twelve players (15%) experienced a subsequent Achilles tendon tear during or after the study period and were included in the overall RTP rate but were excluded from performance analyses owing to the confounding effects of an ipsilateral retear or contralateral tear.

Results: The overall RTP rate was 61.3%. Age, number of prior seasons, position type, or draft round status did not significantly affect RTP when evaluated with Kaplan-Meier analysis. In the season before their injury, players who did RTP played in a significantly greater number of regular season games (13.7) compared with players who did not RTP (8.71) (P = .011). Players who did not RTP exhibited a significant decrease in performance in the season preceding injury (12.7 regular season games played 2 seasons preinjury vs 8.71 regular season games played 1 season prior preinjury;, P = .019). Players who returned did not display a significant change in the number of games played or started in seasons following injury when >1 season after return was evaluated.

Conclusion: Rate of RTP following primary Achilles tendon tears may be lower than previously published. However, for those able to return, performance only in the season immediately following injury appears to be affected; players return to preinjury levels if given the opportunity to play >1 season after injury.

Keywords: Achilles tendon; ankle; football (American); ligaments; physical therapy/rehabilitation.

Figure 1.

Kaplan-Meier analysis evaluating the effect of (A) position type and (B) draft round in which the player was selected on return-to-play rates as a function of months since injury date. Kaplan-Meier curves for (A) unskilled players (blue) and skilled players (red), P = .19; (B) rounds 1-3 (blue), rounds 4-7 (red), and undrafted free agents (green), P = .49.

Figure 2.

Number of games (A) played and (B) started before and after the season of injury between players who did return to play (RTP; red) and players who did not (blue). Data are shown as mean ± SD. (A) A significant decrease in games played occurred between the second and first seasons prior to injury for players who did not RTP (P = .0185). (B) No significant differences were found across seasons for both groups.