Extrinsic Factors Contributing to Achilles Tendon Ruptures During NFL Games From 2010-2023: A Retrospective Analysis

Achilles tendon ruptures are serious injuries that significantly impair performance and career longevity among professional football players. The incidence of these injuries in National Football League (NFL) athletes has increased over the past decade. Given the sport's high physical demands and the potential for long-term functional limitations, understanding the extrinsic factors contributing to Achilles tendon tears is crucial.

The purpose of this study was to evaluate the role of extrinsic factors in the incidence of Achilles tendon ruptures among NFL players. Playing surface, timing within the season, quarter of play, and days of rest prior to the tear were examined. It was hypothesized that Achilles tendon tears would occur more frequently on artificial turf, during the fourth quarter of games, and in the latter half of the regular season.

Descriptive epidemiology study.

Publicly available NFL injury data from 2010 to 2023 were retrospectively reviewed. Injury reports and related articles from major sports media sources were used to identify players placed on the injured reserve due to Achilles tendon ruptures sustained during official games. Descriptive statistics summarized player characteristics. Game-level analyses were conducted using analysis of variance and Pearson chi-square testing, while player-level comparisons utilized 1-sample t tests and chi-square tests of independence. P < .05 was considered statistically significant.

Of 1,477 players initially identified with ankle injuries, 103 players (103 ankles) sustained complete Achilles tendon ruptures across 101 games. The incidence of Achilles tears was highest in 2023 (n = 14 [13.59%]) and 2020 (n = 13 [12.62%]). The highest weekly incidence of tendon tear occurred in week 4 of the regular season (n = 13 [12.62%]). No significant differences in injury patterns were observed based on playing surface (2.68% grass vs 1.88% turf; χ² = 0.18; P = .67), game quarter (P = .18), or season timing (first half 57.42% vs. second half 27.18% of the season, P = .07).

Our study demonstrated that Achilles tendon ruptures in NFL players have increased in frequency since 2020, without significant associations between playing surface, game timing, or season progression. Identifying modifiable external risk factors may help guide injury prevention strategies and optimize player training and conditioning.