Prior Lower Extremity Injury as a Risk Factor for Achilles Tendon Rupture in Professional Soccer Players
Haneef A. Khan, Ashley Rosenberg, Ian Penvose, Amina Khan, Praneeth Tummala, Matthew Quinn, Stephen Marcaccio, Nicholas LemmeBackground:
Achilles tendon rupture (ATR) is a serious injury in professional soccer, often leading to prolonged absence, diminished performance, and increased risk of reinjury. While ATR epidemiology and biomechanics have been extensively studied, the contribution of previous lower-extremity injuries to rupture risk remains incompletely characterized.
Hypothesis:
Given the integrated nature of the kinetic chain, we hypothesized that players with previous injuries to related structures would be disproportionately represented among those sustaining ATR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Injury data were obtained from Transfermark. Professional soccer players with complete ATR from 2001 to 2025 were identified. Previous injuries were categorized into anatomical groups. Players with documented histories were compared with an injured, non-ATR reference population. Categorical variables were summarized as counts and percentages, and continuous time-loss data as means ± standard deviations and medians. Between-group injury risks were quantified using risk ratios. Data aggregation and statistical calculations were conducted in Python.
Results:
A total of 1362 ATR cases were identified from 1,073,633 players, of whom 750 (55.1%) had previous injuries. Among these, the most frequent antecedent pathologies involved the knee (37.9%), thigh (34.5%), and hip/groin (27.9%), followed by ankle (23.6%), Achilles tendon (14.3%), foot (11.9%), and calf (10.8%). Compared with controls, ATR players exhibited higher rates of previous Achilles injuries (107/750 [14.3%] vs 1350/50,000 [2.7%]; 5.3-fold increase;
Conclusion:
This large-scale analysis demonstrates that ATR is rarely an isolated event, with more than half of cases preceded by lower-extremity injuries. The overrepresentation of Achilles, thigh, and foot pathology may support the concept of cumulative injury progression and highlights potential biomechanical links contributing to rupture.