Treatment Strategies and Return-to-Sport Outcomes in High-Performance Athletes With Acute Achilles Tendon Rupture: Multicenter Retrospective Study

Abstract

Introduction

Acute Achilles tendon rupture (AATR) can challenge high-performance athletes, necessitating effective treatment strategies to facilitate their return to play (RTP). How treatment outcomes of non-surgical and surgical approaches affect RTP in high-level athletes remains unclear. Acute Achilles tendon rupture, considered a combination of age-related degeneration and high-energy trauma, suggests stratification based on athlete groups rather than simple age categorization to comprehend the reality of AATR in athletes.

Methods

This multicenter retrospective study included 64 athletes with AATR who underwent either non-surgical or surgical treatment. Athletes were categorized into elite (n = 18) and masters (n = 46) groups. Patient demographics, injury details, treatment, and RTP outcomes were collected. Intensity of Achilles tendon loading was assessed with the modified Halasi score (mHS). Complete RTP (cRTP) was defined as resuming the same sports discipline and competition level as before injury.

Results

In the masters group, post-treatment mHS was significantly lower in the surgically treated versus non-surgically treated group (P = .0322). Complete RTP rate and Achilles tendon total rupture score were not significantly different between treatment groups in either elite or masters categories. In the masters group, the primary immobilization period was significantly longer in the surgical versus non-surgical group (P = .0435). Non-surgical masters patients not achieving cRTP had a significantly longer immobilization period (P < .001). (odds ratio = 0.91; 95% confidence interval = 0.56-1.48; P = .71).

Conclusion

Surgical treatment may decrease post-treatment physical activity intensity in masters athletes, and prolonged immobilization may negatively impact cRTP in non-surgical masters patients. Early functional mobilization is beneficial in both treatment modalities. Treatment strategies and duration of immobilization can potentially impact RTP outcomes in high-level athletes with AATR.