Low return to play and performance in national football league athletes after Achilles tendon rupture: A systematic review

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Clinical studies reporting outcomes following Achilles tendon ruptures in athletes in the National Football League	Review articles
At least 5 patients per cohort	Case reports
Published in a peer-reviewed journal	Cadaveric studies
Article written in English	Fewer than 5 patients per cohort

Table 2 Study characteristics and athlete demographics

Ref.	Level of evidence	Number of players	Number of Achilles	Years data collected	Age	Body mass index (kg/m2)	Years in national football league prior to acute Achilles tendon rupture (years)
Chopra et al[14], 2023	4	5	10	2007-2021	27.8	33.4	5.8
Krill et al[9], 2017	4	44	44	2009-2016	n/r	n/r	n/r
Parekh et al[8], 2009	4	28	31	1997-2002	29	n/r	6
Yang et al[10], 2019	3	80	80	2009-2014	25.6	n/r	3
Bi et al[4], 2023	4	52	52	2019-2021	n/r	n/r	n/r
Ready et al[11], 2021	4	101	101	2009-2016	26.7	31.7	n/r
McCullough et al[7], 2014	4	9	9	2012-2013	25.6	n/r	n/r
Jack et al[6], 2017	3	95	98	1958-2016	28.2	n/r	5.5
Krill et al[15], 2018	4	98	109	2010-2016	26	n/r	n/r
Trofa et al[5], 2017	3	21	21	1988-2012	29.4	33.3	6
Mai et al[13], 2016	4	80	80	2003-2013	27.2	32	4.6
Barton et al[12], 2023	3	63	63	2009-2015	n/r	n/r	n/r

n/r: Not recorded.

Table 3 Distribution of acute Achilles tendon rupture per position, n (%)

Position
Linebacker	65 (19.0)
Wide receiver	41 (11.9)
Defensive end	35 (10.2)
Running back	31 (9.1)
Tight end	26 (7.6)
Corner back	22 (6.4)
Defensive tackle	21 (6.1)
Quarter back	12 (3.5)
Safety	9 (2.6)
Offensive tackle	7 (2.1)
Offensive guard	6 (1.8)
Kicker	5 (1.5)
Corner	4 (1.2)
Punter	3 (0.9)
Long snapper	2 (0.6)
Overall defensive linemen	83 (24.3)
Overall offensive linemen	31 (9.1)
Overall defensive players	257 (56.9)
Overall offensive players	185 (40.9)
Overall special team players	10 (2.2)

Table 4 Timing of acute Achilles tendon rupture and environmental factors

Ref.	Number of players	Number of Achilles	Preseason practice	Preseason game	Regular season	Practice session during regular season	Post-season game	Quarter	Artificial surface	Grass	Indoor/outdoor	Weather conditions
Chopra et al[14], 2023	5	10	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Krill et al[9], 2017	44	44	n/r	n/r	44	n/r	1	1st: 17, 2nd: 15, 3rd: 6, 4th: 5	20	24	n/r	n/r
Parekh et al[8], 2009	28	31	6	5	20	0	n/r	1st: 6, 2nd: 8	15	16	Indoor: 5, outdoor: 26	Sunny: 9, rainy: 9, cloudy: 7, average temperature: 69.7
Yang et al[10], 2019	80	80	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Bi et al[4], 2023	52	52	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Ready et al[11], 2021	101	101	55	10	34	2	1	n/r	57	44	n/r	Average temperature: 67
McCullough et al[7], 2014	9	9	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Jack et al[6], 2017	95	98	63	n/r	35	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Krill et al[15], 2018	98	109	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Trofa et al[5], 2017	21	21	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Mai et al[13], 2016	80	80	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r
Barton et al[12], 2023	63	63	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r	n/r

n/r: Not recorded.

Table 5 Return to play and player performance following acute Achilles tendon rupture

Ref.	Number of players	Number of Achilles	Number of RTP	Mean time RTP (months)	Participation statistics following AATR	Player performance following AATR
Chopra et al[14], 2023	5	10	5	9.3	n/r	n/r
Krill et al[9], 2017	44	44	n/r	n/r	n/r	n/r
Parekh et al[8], 2009	28	31	18	11	11.7 games/season before AATR, 6.7 games/season post AATR	Decreased Power-rankings of 83.0% for RBs, 77.0% for WRs, 73.0% for TEs and 50.0% for quarterbacks
Yang et al[10], 2019	80	80	51	11.9	10.9 games played in 1st season following AATR	n/r
Bi et al[4], 2023	52	52	n/r	n/r	n/r	n/r
Ready et al[11], 2021	101	101	59	n/r	n/r	n/r
McCullough et al[7], 2014	9	9	7	8.9	n/r	n/r
Jack et al[6], 2017	95	98	71	11.2	12.6 games/season, 2.7 seasons, 28.1% playing in national football league 3-years post AATR	n/r
Krill et al[15], 2018	98	109	n/r	n/r	n/r	n/r
Trofa et al[5], 2017	21	21	14	n/r	15 games in the season before AATR, 12.9 games in the 1st season following AATR	SAV pre-AATR: 8.7, SAV post-AATR: 5.6
Mai et al[13], 2016	80	80	58	12.3	1.6 seasons, 27.3 games played	n/r
Barton et al[12], 2023	63	63	36	12	n/r	WR/TE yards/catch pre/post AATR: 11.4/9.9, WR/TE receptions/game pre/post AATR: 2.6/2.3, WR/TE TDs/season pre/post AATR: 2.8/3.6, RB yards/rush pre/post AATR: 4.3/2.4, RB rushes/game pre/post AATR: 13/3.5, RB rushing TDs/season pre/post AATR: 3.8/1, DB/LB tackles pre/post AATR: 64.5/51.1, tackle for loss pre/post AATR: 4.8/3.3, DB/LB sacks pre/post AATR: 2/1.8, DB/LB passes defended pre/post AATR: 5/2.8, DB/LB interceptions pre/post AATR: 1.3/0.8, DB/LB fumbles pre/post AATR: 1.4/0.8, DB/LB defensive TD pre/post AATR: 0.3/0.2

AATR: Acute Achilles tendon rupture; DB: Defensive back; LB: Linebacker; n/r: Not recorded; RBs: Running backs; RTP: Return to play; SAV: Simple ankle value; TD: Touch down; TEs: Tight ends; WRs: Wide receivers.