Last Updated on Wednesday, 09 March 2016 13:58
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I am a 40-year-old male who plays hockey in an adult league once a week. I recently had surgery to repair a torn Achilles tendon. Can I expect to return to hockey and, if so, after how long?
Answer: Achilles tendon tears are relatively common and represent a significant hurdle to individuals who wish to remain active in sports. With high profile athletes like the L.A. Lakers star Kobe Bryant suffering an Achilles tendon rupture and the Ottawa Senators’ Erik Karlsson sustaining an Achilles tendon laceration, interest in these injuries has been high.
The Achilles tendon is the largest and strongest tendon in the body and connects the calf muscles to the heel. Tears or ruptures of the tendon are more common in men than women, typically occurring in individuals 30 years old or greater. The mechanism of Achilles tendon injury is not well known. Theories can generally be divided into the degenerative theory and the mechanical theory. The degenerative theory proposes that the tendon can rupture, or break, due to a progressive breakdown in the tissue quality. This can be caused by certain drugs such as steroids or fluoroquinolone (like Cipro) antibiotics or changes in the types of cells that make up the tendon. The mechanical theory states that the buildup of small tears, or microtrauma, in the tendon eventually leads to tendon tearing. This occurs when small tears build up faster than the body can repair them.
If you suspect that you may have torn your Achilles tendon, it is essential to be evaluated by a healthcare profession. However, up to a quarter of all Achilles tendon injuries are not diagnosed at the first evaluation by a physician, so in some cases a second opinion may be necessary. Common symptoms include an inability to walk, pain, ankle weakness, instability, stiffness, and swelling. Your doctor may use special physical exam tests, ultrasound, or MRI to diagnose your injury.
There are several treatment options for Achilles tendon ruptures. Recommended treatments vary depending on the player’s age, occupation, and level of sporting activity. In older, less active players, casting or ankle immobilization followed by a course of rehabilitation is the least risky of all treatments and has been reported to produce outcomes almost as good as surgery in some patients. In younger, fitter players, surgical repair using one of several techniques is often the recommended treatment.
Rehabilitation following Achilles tendon injuries typically takes several months. Immediately after surgery, players are required to wear a cast or boot for the first 6 to 12 weeks to allow the tendon to heal. Weightbearing is also restricted during this time. The lower leg is usually positioned with the toes pointing downward (plantar flexion) to place the Achilles in the best position for healing. After the walking boot or cast is removed, the player can begin functional rehabilitation where ankle range of motion, muscular endurance, and muscular strength are progressively restored. The rehabilitation process usually takes at least three to five months, though it may take longer in some players. Once rehabilitation is complete and the player is cleared by a physician, it is safe to return to on-ice activities. However, it is essential to ease back into practice prior to returning to competing.
To answer your question, many players, including high profile athletes, experience Achilles tendon injuries and successfully return to competition, although usually at a slightly lower level. You will likely be able to return to on-ice activities after undergoing treatment, though it may take several months of rehabilitation to do so. If you are a highly active player and want to return to your previous level of competition, open surgical repair is likely the best treatment option.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
