Philly.com
Sports Doc
May 1st, 2017

With their second pick in the 2017 draft the Eagles chose cornerback Sidney Jones.  Jones was originally projected as a high first round pick with a lot of potential but then he ruptured his left Achilles tendon during his pro day workout in early March.  Howie Roseman has stated that the Eagles medical staff are confident that Jones will make a full recovery from his surgery.  But what does the research say on returning to the NFL following an Achilles tendon rupture?  Will the Eagles' 43rd pick be a steal or a bust?

The risk of Achilles tendon rupture is low — around 18 per 100,000 people. Ruptures typically occur in males between 30 and 50 years old and account for around 40 percent of all operative tendon repairs. Approximately 75-80 percent of cases can be attributed to participation in athletic activities, including ball and racquet sports. Re-rupture rates for surgical repair is low at 3-4 percent.

However, returning to sports following Achilles tendon rupture can be difficult. A 2009 study by Parekh et al showed that 30 percent of NFL players did not return to play following this injury.
A more recent article from 2016 in the American Journal of Sports Medicine reported on 80 Achilles tendon ruptures from March 2003 to 2013.  They found a return to play rate of 72.5 percent with a return to play time frame of one year +/- four months.  The study showed a significantly higher proportion of defensive lineman who sustained the injury.  Their results showed a 9.3 percent decrease in return to play with each increasing year of age and 6.3 percent decrease with each increasing year of experience. 

Achilles tendon repairs led to significantly fewer games played following return (27 games) compared to many other procedures. These players showed a reduction in performance during their first season following surgery but returned to pre-injury levels between their second and third years.  Findings showed that Achilles tendon repair — as well as ACL reconstruction and patellar tendon repair — have the greatest effect on the careers of NFL players.
What does this all mean for Sidney Jones?  Although Achilles tendon ruptures are a difficult injury to recover from, Jones has some advantages.  His young age, 20, and limited NFL seasons are a positive predictor for return to play.  Although research hasn’t looked at draft position and return to play from Achilles tendon injury, this has been studied for injuries to the ACL.  A 2010 paper in the American Journal of Sports Medicine showed that being selected in the first 4 rounds of the NFL draft was highly predictive of return to play. 

With this information, the odds are with Jones to have a successful recovery from Achilles tendon surgery.  Jones may not be ready for the 2017-18 season but we can hope to see him in an Eagles jersey for years to come.

Philly.com
​Sports Doc
OCTOBER 28, 2016 

In Sunday’s Eagles game against the Minnesota Vikings, cornerback Ron Brooks went down with a non-contact right knee injury in the first half.  The Eagles have confirmed that he suffered a ruptured quadriceps tendon that will require surgery, making it likely that he will be out for the season. 

Quadriceps tendon injuries occur when the tendon tears away from the patella (knee cap). It typically result from a forceful eccentric load where the muscle is resisting bending of the knee. They commonly occur in males over 40 during sporting activities or resulting from a fall.  Other potential non-traumatic causes include tendinosis, use of corticosteroids, or the use of specific antibiotics (fluoroquinolones). However, this injury is very rare in football.

While Achilles tendon ruptures are becoming more frequent in the NFL, ruptures to the quadriceps tendon are hardly seen.  A 2013 study by Boublik in the American Journal of Sports Medicine looked at quadriceps tendon ruptures in the NFL over a 10-year period starting in 1994. During that time, the study found only 14 quad tendon ruptures in 10 years. By comparison, NFL injury rates for Achilles tendon ruptures are between 4-10 per year with the 2015-16 season seeing more than 15. 

The injury can vary in severity from a small partial tear that heals without surgery, to a larger partial tear or complete rupture, both of which require surgery. 

Recovery from a ruptured quadriceps tendon can be difficult, particularly for professional athletes.  There are many factors that can influence return to play including partial versus complete tear, age of the player, years in the league, and pre-jury performance (starter vs substitute). 

​Boublik et al found in their studies that only 50 percent of the athletes with this injury returned to play. By comparison, 80 percent of athletes return to play after a patellar tendon rupture, while another study by Parekh et al in 2009 found that 70 percent of Achilles tendon ruptures return sports.

Only time will tell if Ron Brooks will return to his pre-injury level of play. Hopefully, he will prove the statistics wrong.

Philly.com
Sports Doc
Posted: 11/16/15

Add another player to the Eagles “out for the season” list. Jordan Hicks ruptured his left pectoralis major in the final minutes of this past Sunday’s game against Dallas. The injury occurred as Hicks reached his left arm out to tackle Cowboys receiver Cole Beasley. These injuries are usually the result of an eccentric overload on an outstretched arm. The injury occurs as the player is trying to move the arm forward (ie tackle) as the arm is forcefully pushed backwards (ie player running through the tackle). This sudden eccentric load causes the tendon to either rupture near its attachment on the humerus or to pull off of the humerus itself.

The pectoralis major muscle originates on the sternum and ribs and inserts on the proximal humerus at the bicipital grove. The main function of the pectoralis major is to elevate and internally rotate the arm and is the key muscle when performing activities that require power in these planes of motion. Most athletes are unable to return sports that require pushing and tackling, such as football and wrestling, without surgical repair.

A 2014 study by Tarity et al looked at pectoralis major ruptures in the NFL from 200-2010. They found 10 complete ruptures during this period. 5 of 10 were in defensive players and 9 of 10 occurred during games. All 10 occurred on the football field with none occurring in the weight room. The authors were able to obtain the mechanism of injury for 6 of 10, with all of the reported mechanisms involving either tackling or blocking. The incidence of pectoralis major ruptures during the 11-year study was 0.004 showing that it is a rare injury in professional football.  All 10 athletes returned to play in the NFL but the study was unable to obtain data to further investigate the long term effect the injury may or may not have had on their careers.  Previous studies have shown a much higher success rate with surgical repair versus non-operative treatment with 70% of athletes having excellent results.

The results of the NFL study are very promising for return to play after pectoralis major injuries. This is great news for Jordan Hicks. I’m sure we’ll see him back on the practice field sometime this summer and in the starting lineup come August.

Philly.com Sports Doc
Posted Monday, October 20, 2014

If you didn’t see it live, I’m sure you’ve seen the video of New York Giants' Victor Cruz’s knee injury. He wasn’t tackled. His knee didn’t twist in some abnormal way. How did he tear his tendon on such a routine play?

Patellar tendon ruptures are a rare injury. A 2011 study in the American Journal of Sports Medicine showed that there were only 21 isolated patellar tendon ruptures over a ten year period from 1994-2004. This study showed an 80% return to play in the NFL following surgery. The big question is even with a return to football, will he be the same player he was before surgery?

The mechanism of injury is still debatable. Research shows that it takes a force of approximately 17 times body weight to tear the patellar tendon which is why this is such an uncommon injury. In sports, it appears to be the result of an eccentric flexion load followed by forceful knee extension. If you watch Cruz’s injury closely, it appears that his knee is flexing under his body weight as he forcefully tries to push off to catch the pass. The eccentric loading combined with the concentric push off likely created an extreme amount of strain on the tendon resulting in rupture. (Get a rehash of injury here)

Patellar tendon rupture requires an immediate repair of the torn tendon. The type of surgery performed is dictated by where the tendon tore and if the tendon tissue is healthy. If the tendon tore in the middle, the two ends are sewn back together. If the tendon tore closer to the bone, it can be sutured back down. If the tissue is not healthy, i.e. chronic patellar tendonitis, the repair can be augmented with a cadaver graft.


Rehab involves a period of immobilization followed by rehabilitation to regain range of motion and strength. Players are usually braced for approximately 6 weeks following surgery. During this time there is a gradual progression of knee flexion range of motion to allow the tendon to heal while trying to limit the amount of post-operative stiffness that will occur. Over the next 4-5 months rehab focuses on regaining full flexibility and strength with gradual progression to sports activities such as running, agility exercises, and plyometrics. Return to sports usually takes a minimum of 6 months.

As the NFL study showed, 80 percent of players return to football, but their definition of return to play was participating in one regular season NFL game. There is a big difference between playing in one NFL game and returning to pro bowl level of play. Only time will tell if Cruz will be celebrating touchdown receptions with his salsa dance next season.