Football is starting, and we have already seen several season-ending injuries. The Cincinnati Bengals' tight end, Reggie Kelly, suffered an Achilles tendon rupture at the beginning of training camp, which meant that his 2009 season was over before it began.
The Achilles tendon is a tendon at the back of the leg that attaches the calf muscles (gastrocsoleus muscle complex) to the heel bone (or calcaneous). The tendon functions to help plantar-flex the foot (foot/toes point down towards ground), which is crucial during walking, running and jumping. It is one of the thickest and strongest tendons in the body. During running it can experience loads 6-8x one's body weight.
About 80% of the time, Achilles tendon tears occur during sporting activities. In older patients, the Achilles tendon can tear as a result of chronic weakening due to overuse. Certain medical condition or medications have also been associated with Achilles tendon tears due to their effect on tendon composition. In younger patients, if is often an acute event that occurs when one starts to run. Athletes will feel an extreme pain in the back of their ankle. Oftentimes they feel like they have been shot or hit with a bat in the back but when they look around, no one is near them.
The diagnosis is usually easy to make as the patients have a palpable defect in the back of their ankle where the tendon has split in half. They will have weakness pushing off with that foot. MRI or ultrasound can be used to confirm the diagnosis. Once the diagnosis of an Achilles tendon tear is made, the patient has two treatment options: surgery or casting.
In patients who are older, lower demand, or unable to undergo surgery, casting can provide good results. The goal of casting is to hold the foot and ankle in a position to bring the torn ends of the tendon next to each other. This allows the tendon to then slowly heal over time. Casting or bracing for up to 3 months or more is often necessary, but it does obviate the need for surgery Again, the results with this treatment can be good, but there is a slight increased risk of re-rupture and the tendon typically isn't as strong as it was before the injury.
Surgery can have some benefits over cast treatment. The first is that it results in a significantly lower rate of re-rupture. The second is that it better establishes normal strength in the tendon. Surgery is not without risks though. Infection, wound breakdown, and scar tissue formation are all real concerns after surgery. Wound breakdown and infection can occur due to the swelling and the relatively poor vascularity to the area. When treating patients, it is imperative to present them with the risks and benefits of each treatment option then make a decision based on what is best in their case. That being said, high performance athletes with Achilles tendon tears are almost always treated with surgery. Again, because this provides a stronger tendon that is less likely to re-rupture.
Recovery after surgery takes a few months. Weightbearing is protected, to a certain extent, in the immediate postoperative period. The patient is then progressed to full weightbearing followed by strengthening over the next few weeks and months.
Based on reports, Reggie Kelly had surgery a few weeks ago, which means this season is over for him. Good news is that players often do well after such a procedure so he should be ready to go for next years training camp.