CLINICAL REVIEW: Achilles tendon rupture treated with surgical repair

By Pip Sail

However, there was very limited data on which to advise professional football (soccer) players.9-11 This study aimed to analyse the time to return to training and match participation following ATR in professional footballers and the occurrence of complications including re-rupture rate.

The Players were identified through internet-based injury reports, player profiles/biographies and press releases as reported by Jack et al,12 using the keywords 'Achilles Tendon Rupture’ and ‘Transfermarkt’ and were considered eligible if they were found to have an ATR and repair between 2008 and 2018 and were enrolled as a professional footballer at the time of injury.

96% of male professional football players after suffering an index ATR and having surgical repair returned to unrestricted football practice after a mean of 199 +/- 53 days from injury. Players who were classified ’international’ returned to play a mean 32+/11 days earlier. There was no difference between player positions and time to return. All players who returned to training participated in official competitions after ATR. The mean time for return to competition was 274 +/- 114 days. The number of matches played 2 seasons and 1 season before the ATR was similar for those that returned to the same level of play and those who did not and the number of matches played the first season and the second season after return to play were significantly higher in those that resumed their level of play. 8% of the players who played in at least two full seasons after returning to play had a re-rupture. There were no predictors of re-rupture.

Participation in a national team was a predictor of faster recovery, the assumption being that elite athletes have access to top level care and stronger motivation to recover. A 6-7 month lay-off should be considered a reasonable expectation for professional players. Return to competition occurred on average around 9 months after the injury and more than 2 months after re-joining the team which shows that the physical and mental fitness required to compete is slow to return after ATR. Only 82% of athletes that returned to a second season were able to perform at their pre-injury status. Footballers aged 30+ and those who sustained rerupture were more likely not to return to their preinjury level and therefore extreme care should be used to prevent Achilles re-injures and realistic expectations of not returning to their desired performance should be considered in athletes experiencing ATR in their 30’s. A higher re-rupture risk was reported in lower divisions. It is possible that lower divisions are not able to demand expensive and high standards of rehabilitation. Of more importance is that several reruptures occurred during early rehabilitation or early return to sport highlighting the risk of re-injury in the case of incomplete recovery, inadequate rehabilitation and over estimation of readiness.

Almost every professional football player was able to return to unrestricted practice and competition after a mean of 7-9 months; complete recovery to full and continuous match participation could be delayed for up to 2 seasons. Only 82% of players were still