Achilles Tendon injuries - Dallas Cowboys Forum

**jobberone** · 03-16-2005

First let me say I'm not an orthopedist but another type of practioner in the surgical field and additionally I'm retired. So I don't have day to day contact as I once did. However here is a merged answer from true orthopedic experts and a little of my own knowledge.

From a colleague: In an athlete I would recommend primary repair of the tendon and then begin early range of motion protected by a hinged CAM boot at 10 to 14 days when the sutures come out. Stationary bike may begin at 2-3 weeks and by 8 weeks "stair master". At the 3rd month I allow single heel rises and jogging and in general increase in activities. Good luck. Hope this helps.

If the tear is off the calcaneus and there is sufficient good tendon to repair to the bone, use 3 4-prong mini anchors to do the repair.

Also reoccurence incidence in new studies show rerupture rate similar for surgical vs. non-surgical. With the aggressive rehab approach I have listed above there is very little loss of function.

From me: Tendons gradually originate from the muscle from the musculotendinous area to the insertion site becoming less and less muscle and more and more tendinous as it nears the bone. It is just very strong tendon that inserts onto and into the bone. Ruptures may occur anywhere along the axis of the muscle/tendon from origin of muscle to insertion. They may be partial or complete. Often they will pull some of the bony insertion site off with complete tears.

The achilles is formed from your calf muscle and inserts into the calcaneus or your heel. That muscle allows you to flex your foot or push it downward. The obvious implications are you can't raise yourself well on your toes, push off, run or even walk well much less play football.

It can tear proximally toward the calf in which case it's likely to be a less complete tear. The closer to muscle the more difficult it is to suture and repair but the more likely it is to scar and heal. It is more like a pulled muscle but if it's a grade 4 (1-4) or the worse then it's complete and can be a problem. It's hard to suture muscle together and get it to stay. That's why biceps tears which were complete and in the muscle were a problem. I don't know what they do these days with artificial materials to help. I'd have to ask.

But for the tear at the heel you can just reattach it and then rehab. It's a little more complicated than that but not much.

I'm glad to hear there is little loss of function these days. Orthopedics advances probably more than any other field of surgery on a day to day basis. There is much more emphasis on the part of physicians to heal patients without loss of function now and there are lots of new gadgets out there to mobilize injuries from day one now. The days of joint fusions for the most part are gone even in the hand with a few exceptions. And long lived casts are generally a thing of the past as well. Athletes benefit from all the resources thrown at them too.

I wanted to wait to answer the questions about Blade after taking with the real experts.

I hope this doesn't bore you and the mods are welcome to delete it.

I hope Blade will come back from this and complete his career in football.

ravidubey · 03-16-2005

Thanks; I learned a lot from this post.

Duane · 03-16-2005

Cool stuff. I was thinking that an injury like Blade's might not be as bad for a big man as it is for someone who relies on speed.

Chocolate Lab · 03-16-2005

That's just awesome, Jobberone. I love these posts.

They've really come a long, long way on these and really all serious injuries lately, haven't they? Achilles tears used to be career ending most of the time, but they seem much more routine now. I was surprised to read that Bickerstaff was coming along just fine from his achilles tear last offseason and should be fine for camp, or even the offseason program. And of course Vinny tore his in 1998 but came back okay.

Am I correct in assuming that the rehab process and not the actual surgical procedure used is the reason for the greater success rate (and shorter recovery time) on these injuries these days?

**jobberone** · 03-16-2005

Quote:

Originally Posted by Chocolate Lab

That's just awesome, Jobberone. I love these posts.

They've really come a long, long way on these and really all serious injuries lately, haven't they? Achilles tears used to be career ending most of the time, but they seem much more routine now. I was surprised to read that Bickerstaff was coming along just fine from his achilles tear last offseason and should be fine for camp, or even the offseason program. And of course Vinny tore his in 1998 but came back okay.

Am I correct in assuming that the rehab process and not the actual surgical procedure used is the reason for the greater success rate (and shorter recovery time) on these injuries these days?

It's a combination of the rehab program which starts as soon as they hit the floor post op, newer surgical techniques and especially newer suture materials or what I call playtoys like suture guns and the like.

The use of tendon grafts, cadaver material and new suture materials which also make anchors, screws and the like have helped a lot.

But mobilization and rehab have the most to do with a return to normal function. In fact they have to be careful with everyone about making the injured limb stronger than the other esp in athletes. So they are very careful to symmetrically strenghten limbs.

Glad you guys enjoyed. I thought it might be boring and techical.

Qwickdraw · 03-16-2005

Isn't this basically the same injury that RB Bickerstaff is returning from?

If so, we should be getting a look at the recovery results of one individual soon enough.

Seven · 03-16-2005

Quote:

Originally Posted by jobberone

First let me say I'm not an orthopedist but another type of practioner in the surgical field and additionally I'm retired. So I don't have day to day contact as I once did. However here is a merged answer from true orthopedic experts and a little of my own knowledge.

From a colleague: In an athlete I would recommend primary repair of the tendon and then begin early range of motion protected by a hinged CAM boot at 10 to 14 days when the sutures come out. Stationary bike may begin at 2-3 weeks and by 8 weeks "stair master". At the 3rd month I allow single heel rises and jogging and in general increase in activities. Good luck. Hope this helps.

If the tear is off the calcaneus and there is sufficient good tendon to repair to the bone, use 3 4-prong mini anchors to do the repair.

[View Full Quote]Also reoccurence incidence in new studies show rerupture rate similar for surgical vs. non-surgical. With the aggressive rehab approach I have listed above there is very little loss of function.

From me: Tendons gradually originate from the muscle from the musculotendinous area to the insertion site becoming less and less muscle and more and more tendinous as it nears the bone. It is just very strong tendon that inserts onto and into the bone. Ruptures may occur anywhere along the axis of the muscle/tendon from origin of muscle to insertion. They may be partial or complete. Often they will pull some of the bony insertion site off with complete tears.

The achilles is formed from your calf muscle and inserts into the calcaneus or your heel. That muscle allows you to flex your foot or push it downward. The obvious implications are you can't raise yourself well on your toes, push off, run or even walk well much less play football.

It can tear proximally toward the calf in which case it's likely to be a less complete tear. The closer to muscle the more difficult it is to suture and repair but the more likely it is to scar and heal. It is more like a pulled muscle but if it's a grade 4 (1-4) or the worse then it's complete and can be a problem. It's hard to suture muscle together and get it to stay. That's why biceps tears which were complete and in the muscle were a problem. I don't know what they do these days with artificial materials to help. I'd have to ask.

But for the tear at the heel you can just reattach it and then rehab. It's a little more complicated than that but not much.

I'm glad to hear there is little loss of function these days. Orthopedics advances probably more than any other field of surgery on a day to day basis. There is much more emphasis on the part of physicians to heal patients without loss of function now and there are lots of new gadgets out there to mobilize injuries from day one now. The days of joint fusions for the most part are gone even in the hand with a few exceptions. And long lived casts are generally a thing of the past as well. Athletes benefit from all the resources thrown at them too.

I wanted to wait to answer the questions about Blade after taking with the real experts.

I hope this doesn't bore you and the mods are welcome to delete it.

I hope Blade will come back from this and complete his career in football.

Delete it?! Lots of work in this here post. Good information. Thank you for the effort I appreciate it.

conner01 · 03-16-2005

i think the key is does willie have the motivation to put in the work it will take to come back? so far he has'nt shown much in the line of hard work.if he does'nt here he's done.if he gets his head straight and puts in the work not only can he come back but may be a better player for it.

**jobberone** · 03-16-2005

Quote:

Originally Posted by conner01

i think the key is does willie have the motivation to put in the work it will take to come back? so far he has'nt shown much in the line of hard work.if he does'nt here he's done.if he gets his head straight and puts in the work not only can he come back but may be a better player for it.

They probably will motivate him and this could be a plus for him to keep in shape as they will have him under the microscope for months.

Problem is not keeping him in aerobic shape but his weight training will be limited for awhile. And Willie is the only one who can stay in shape, do the rehap and push away from the table. Reservations noted and I agree. He's got something to prove. Hope he makes it.

Seven · 03-16-2005

Quote:

Originally Posted by jobberone

They probably will motivate him and this could be a plus for him to keep in shape as they will have him under the microscope for months.

Problem is not keeping him in aerobic shape but his weight training will be limited for awhile. And Willie is the only one who can stay in shape, do the rehap and push away from the table. Reservations noted and I agree. He's got something to prove. Hope he makes it.

Put me on the "Willie-Wagon". I'm pulling for him also. He's got God given talent for a big man, he's just too young to realize it. Willie.....you could retire by the age of 35!!

Cbz40 · 03-16-2005

Thanks jobber I find this type of post very interesting and fascinating.

Skip · 03-16-2005

Thanks for the INFO, I really like hearing this from people that are doing more than speculating. Good Post!!!!!!!!

underdark · 03-16-2005

great post sawbones!

heavyg · 03-16-2005

I had a partial tear of my left achilies. Treated under workers comp. LOL...well it was origenally diagnosed as a "sprain or strain". Was given multiple cortizone injections until I refused anymore. Was then released to full duty with about 2 yrs worth of anti-inflamitory meds. It wasnt until 2 yrs later when I ran out of meds and went to my own doctor that it was found I had scar tissue from the origenal tear. Re-opened my case and ended up retiring over it. Had two doctors that said the surgery may or may not help me. Of course these were workers comp doctors and they are not the best pair or use the best methods to repair you. My 2 cents is the injury absolutely SUX ;-)

dthahn · 03-16-2005

I had a complete tear of my right achilles midway between the heel and calf muscle. The top part of the tendon had rolled up to the calf. After the surgery, I was in a cast for 5 1/2 months so I disagree with the rehab schedule of the original poster. No way you start rehab after a few weeks. My orthopedic surgeon was the former surgeon for the San Diego Chargers too. Maybe if it's only a minor tear, but I appreciate the info.