Updated: Dec 10, 2019
Achilles tendon rupture is a game changing injury for any athlete; however, in Ryan Broyles situation it will be a session ending injury. The Achilles is the thickest and strongest tendon in the human body. In football the primary mechanisms of injury include sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot, and violent dorsiflexion of a plantar flexed foot. This was seen in Ryan's punt return in yesterdays game. Recent literature as discussed openly about conservative care of casting in such injuries; however, in Ryan's profession casting and waiting months is not an option. Clinically these injuries are assessed in the office with know real need for advance imaging except MSK ultra-sound to assess gaping of the tendon. In acute injuries as seen yesterday surgery is recommended as soon as possible.
Tomorrows surgery may appears like this:
Incision placement- medial
Dissection of the ruptured tendon
Assessing the 3 cm gaping
Debriding the loose mop ends of the tendon
Carefully repairing the blood supply of the tendon
At times when the repair needs some increase strength or in athletes I will use Graftjacket (tissue regeneration matrix) for reinforcement.
Reconstruction with Graftjacket
Then repair the paratenon
Post operative I will have the patient non-weight bear for 4 weeks with active range of motion after 2 weeks in the splint. The most important during the recovery, especially with a professional athlete is very active postoperative rehabilitation combined with short-term brace immobilization and slow return to weight-bearing will provide excellent results for most patients. One of the most common long term complications is weakness in end-range plantar flexion (shortened muscle), decreased passive joint stiffness in dorsiflexion, and the inability to perform a heel rise when initiated from a plantarflexed position. These impairments have important functional implications for activities such as landing from a jump when catching the football. Weakness in end-range plantar flexion in my opinion is unrecognized problem after Achilles tendon repair.
I hope the best for Ryan and will await his return to Ford field
Darryl J Martins DPM, FACFAS
Double Board Certified Surgeon
Diplomate, American Board of Podiatric Surgery
Certified in Foot Surgery, Certified in Reconstructive Rearfoot/Ankle Surgery
Diplomate, American Boards of Multiple Specialties in Podiatry,
Board Certified in Diabetic Limb Salvage and Reconstruction