DOI: 10.1177/23259671261449641 ISSN: 2325-9671

Achilles Tendon Injuries in Major League Soccer: A 10-year Analysis of Injury Rate, Return to Play, and Performance Metrics

Brian Forsythe, Catherine Hand, Francis Hand, Henry Eilen, Matthew Varano, Jared Sasaki, Camden Bohn, Anne Timmermann, Lauren Fertig, Eric Giza, Robert H. Brophy, Bert Mandelbaum, Kirk McCullough
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Background:

Injuries to the Achilles tendon, such as tears or ruptures, are commonly observed among elite athletes. These injuries can be debilitating for professional soccer players, leading to prolonged recovery and potential performance declines.

Purpose:

To investigate the annual incidence, return-to-play (RTP) duration, and postinjury performance outcomes of Major League Soccer (MLS) players who sustained Achilles tendon injuries from 2010 to 2021.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This retrospective matched-cohort study evaluated MLS players with Achilles tendon injuries from 2010 to 2021, identified through the MLS Injury Surveillance database, and compared outcomes, including RTP duration, between players with ruptured and nonruptured (soreness, contusion, inflammation, irritation, sprain, tendinosis, tendinitis) injuries. Uninjured controls were matched 2:1 by age, position, and MLS experience. Annual injury incidence, RTP duration, and performance metrics, including games played, minutes played, goals, assists, and defensive contributions, were compared between injured and control cohorts. Multivariate linear regression was performed to identify independent predictors of RTP duration, adjusting for age, player position, injury type, mechanism of onset, field type, weather condition, and injury period. Statistical analyses set significance at P ≤ .05.

Results:

The mean RTP for ruptured Achilles injuries (n = 20) was 229 days, with no significant difference between 2010-2015 and 2016-2021 ( P = .718). Nonruptured injuries (n = 352) had a significantly shorter RTP of 14.9 days versus rupture injuries with an RTP of 229 days ( P < .001). Player age was significantly associated with RTP time, with younger players (≤26 years) exhibiting prolonged RTP durations (303.56 ± 112.97 days) compared to older players (>26 years) (168.09 ± 99.66 days; P = .017). There was no difference in RTP with field type (artificial turf vs grass, P = .59). Reinjury rates increased over time but were not statistically significant ( P = .77). Following multivariate analysis, injury type was the only statistically significant factor affecting RTP duration, with ruptured Achilles injuries associated with significantly increased time missed compared to nonrupture injuries (95% CI, 171.15-264.11 days; P < .001). Forwards with ruptured Achilles injuries exhibited a decline in games played in the index year (−9.00 ± 8.49 vs 3.00 ± 1.73 games; P = .041). Midfielders with ruptured Achilles injuries demonstrated a significantly greater increase in goals than controls in the index year (1.00 ± 1.41 vs −0.43 ± 0.25 goals; P = .004) and a smaller decline in assists than controls (−0.50 ± 2.83 vs −1.00 ± 2.31 assists; P = .024) relative to preinjury performance. Among goalkeepers, rupture injuries were significantly associated with declines in games played in the first year postinjury (−20.50 ± 16.26 vs 1.00 ± 1.26 games; P = .050) and in the second year postinjury (−31.00 ± 4.24 vs −3.50 ± 5.85 games; P = .006). Rupture injuries were associated with a greater decline in clean sheets in the first year postinjury (−6.01 ± 0.71 vs −0.75 ± 2.99 clean sheets; P = .041) and second year postinjury (−5.98 ± 0.02 vs −2.50 ± 2.08 clean sheets; P = .024).

Conclusion:

Our study demonstrated that Achilles tendon ruptures in MLS players were associated with substantial recovery burden and long-term performance declines, particularly among goalkeepers. These findings suggest a potential need for position-specific rehabilitation strategies and structured RTP protocols aimed at optimizing recovery and performance retention in professional soccer players.

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