Who kicked me from behind?

Thousands of New York Jets fans felt like this was their year. The team had signed quarterback Aaron Rodgers, the missing piece needed to get them to the Super Bowl. They excitedly watched the kickoff in the first game of the season. Not 5 minutes off the clock, Rodgers crumpled to the ground as he scampered out of the pocket. The worst fears of coaches, players and everyone routing for the Jets were soon realized: Aaron Rodgers ruptured his Achilles tendon and was most likely out for the remainder of the season.

The Achilles tendon connects the calf muscles to posterior aspect of the heal and is crucial with any ambulatory movement. It is the largest and strongest tendon, but interestingly it is the most ruptured, making up to 20% of all ruptures. (Huttunen 2014 Am J Sports Med). The number of ruptures is increasing, believed to be related to the increasing age of the population, increasing number of obese, and increasing participation in sports (Raikin 2013 Foot Ankle Int). My uncle recently ruptured his Achilles while playing tennis. Besides Aaron Rodgers, other famous athletes have ruptured their Achilles tendon such as Kevin Durant, Kobe Bryant and Grayson Boucher (“The Professor”).

Men are more commonly affected, and the average age of occurrence is 40 years old. Aaron Rodgers happens to be 39 years old. Younger athletes are at higher risk when performing more high energy sports or sports that require quick change of direction movements. Commonly, patients will report here a popping sound or report feeling as if someone had kicked them in the back of the ankle. Once the Achilles ruptures, they will experience acute pain and likely be unable to walk with weight placed on that side.

Physical examination can be confirmed with a positive Thompson test, decreased plantar flexion strength, palpable defect in the tendon area and increased passive ankle dorsiflexion. MRI or ultrasound can be used to confirm the diagnosis.

There is controversy in management of Achilles tendon ruptures in terms of which is the best way to fix it: surgery or conservative management. Some (Bruman 2014 Injury) report the tendon heals faster and many professional athletes will prefer this method as to return to playing quicker. Surgery usually involved direct reconnection of the ruptured tendon. Other reports find no surgery will ultimately result in the same functionality as surgery once the tendon heals on its own. There is also the benefit of avoiding wound complications like infection. Aaron Rodgers elected to have surgery. His surgeon utilized a newer technique involving a SpeedBridge which supposedly protects the tendon and accelerate the rehabilitation process (www.arthrex.com). Reports currently indicate Rodgers is ahead of schedule in terms of recovery and that he hopes to return to the Jets by playoffs.