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World J Meta-Anal. Mar 18, 2026; 14(1): 111108
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.111108
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.111108
Low return to play and performance in national football league athletes after Achilles tendon rupture: A systematic review
James J Butler, Department of Orthopedic Surgery, Royal College Surgeons in Ireland, Dublin 18, Ireland
Davis Hedbany, Department of Orthopedic Surgery, Suny Upstate Medical University, New York, NY 13210, United States
Charles C Lin, Luilly Vargas, Nathaniel P Mercer, Bradley A Lezak, Alexander Tham, Jared Rubin, John G Kennedy, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10002, United States
Matthew T Kingery, Department of Foot and Ankle, NYU Langone Health, New York, NY 10002, United States
Author contributions: Butler JJ was responsible for conceptualization, methodology, data curation, formal analysis, writing original draft; Hedbany D was responsible for data curation, investigation, writing review and editing; Lin CC was responsible for data curation, validation, visualization, writing review and editing; Vargas L was responsible for investigation, resources, writing review and editing; Kingery MT was responsible for methodology, supervision, writing review and editing; Mercer NP was responsible for formal analysis, validation, writing review and editing; Lezak BA was responsible for resources, project administration, writing review and editing; Tham A was responsible for investigation, writing review and editing; Rubin J was responsible for supervision, writing review and editing; Kennedy JG was responsible for conceptualization, supervision, project administration, writing review and editing; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: Kennedy JG is a consultant for Arthrex and In2Bones; Kennedy JG receives financial support from Mr Winston Fisher, the Ohnell Family Foundation, and Ms Tatiana Rybak. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/Licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. The authors report no other conflict of interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: James J Butler, Research Fellow, Department of Orthopedic Surgery, Royal College Surgeons in Ireland, 123 St Stephen‘s Green, Dublin 18, Ireland.
Received: June 23, 2025
Revised: September 26, 2025
Accepted: December 29, 2025
Published online: March 18, 2026
Processing time: 260 Days and 6.6 Hours
Revised: September 26, 2025
Accepted: December 29, 2025
Published online: March 18, 2026
Processing time: 260 Days and 6.6 Hours
Core Tip
Core Tip: This systematic review investigates outcomes following acute Achilles tendon rupture (AATR) in national football league athletes. AATR is a serious injury associated with a 66.2% return-to-play rate and significant post-injury performance decline, regardless of player position. The review highlights decreased career longevity, positional variability in outcomes, and the potential impact of inactivity periods – such as during the coronavirus disease 2019 pandemic – on injury risk. These findings underscore the career-threatening nature of AATR in elite-level athletes.