{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:40:21Z","timestamp":1786538421849,"version":"build-2736575974"},"reference-count":29,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Injuries to the Achilles tendon, such as tears or ruptures, are commonly observed among elite athletes. These injuries can be debilitating for professional soccer players, leading to prolonged recovery and potential performance declines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate the annual incidence, return-to-play (RTP) duration, and postinjury performance outcomes of Major League Soccer (MLS) players who sustained Achilles tendon injuries from 2010 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective matched-cohort study evaluated MLS players with Achilles tendon injuries from 2010 to 2021, identified through the MLS Injury Surveillance database, and compared outcomes, including RTP duration, between players with ruptured and nonruptured (soreness, contusion, inflammation, irritation, sprain, tendinosis, tendinitis) injuries. Uninjured controls were matched 2:1 by age, position, and MLS experience. Annual injury incidence, RTP duration, and performance metrics, including games played, minutes played, goals, assists, and defensive contributions, were compared between injured and control cohorts. Multivariate linear regression was performed to identify independent predictors of RTP duration, adjusting for age, player position, injury type, mechanism of onset, field type, weather condition, and injury period. Statistical analyses set significance at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2264 .05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean RTP for ruptured Achilles injuries (n = 20) was 229 days, with no significant difference between 2010-2015 and 2016-2021 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .718). Nonruptured injuries (n = 352) had a significantly shorter RTP of 14.9 days versus rupture injuries with an RTP of 229 days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Player age was significantly associated with RTP time, with younger players (\u226426 years) exhibiting prolonged RTP durations (303.56 \u00b1 112.97 days) compared to older players (&gt;26 years) (168.09 \u00b1 99.66 days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .017). There was no difference in RTP with field type (artificial turf vs grass,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .59). Reinjury rates increased over time but were not statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .77). Following multivariate analysis, injury type was the only statistically significant factor affecting RTP duration, with ruptured Achilles injuries associated with significantly increased time missed compared to nonrupture injuries (95% CI, 171.15-264.11 days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Forwards with ruptured Achilles injuries exhibited a decline in games played in the index year (\u22129.00 \u00b1 8.49 vs 3.00 \u00b1 1.73 games;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .041). Midfielders with ruptured Achilles injuries demonstrated a significantly greater increase in goals than controls in the index year (1.00 \u00b1 1.41 vs \u22120.43 \u00b1 0.25 goals;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004) and a smaller decline in assists than controls (\u22120.50 \u00b1 2.83 vs \u22121.00 \u00b1 2.31 assists;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .024) relative to preinjury performance. Among goalkeepers, rupture injuries were significantly associated with declines in games played in the first year postinjury (\u221220.50 \u00b1 16.26 vs 1.00 \u00b1 1.26 games;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .050) and in the second year postinjury (\u221231.00 \u00b1 4.24 vs \u22123.50 \u00b1 5.85 games;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006). Rupture injuries were associated with a greater decline in clean sheets in the first year postinjury (\u22126.01 \u00b1 0.71 vs \u22120.75 \u00b1 2.99 clean sheets;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .041) and second year postinjury (\u22125.98 \u00b1 0.02 vs \u22122.50 \u00b1 2.08 clean sheets;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .024).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our study demonstrated that Achilles tendon ruptures in MLS players were associated with substantial recovery burden and long-term performance declines, particularly among goalkeepers. These findings suggest a potential need for position-specific rehabilitation strategies and structured RTP protocols aimed at optimizing recovery and performance retention in professional soccer players.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261449641","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:44:17Z","timestamp":1786358657000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Achilles Tendon Injuries in Major League Soccer: A 10-year Analysis of Injury Rate, Return to Play, and Performance Metrics"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1665-5872","authenticated-orcid":false,"given":"Brian","family":"Forsythe","sequence":"first","affiliation":[{"name":"Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Hand","sequence":"additional","affiliation":[{"name":"UT Health San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Hand","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Eilen","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Varano","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4846-7605","authenticated-orcid":false,"given":"Jared","family":"Sasaki","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camden","family":"Bohn","sequence":"additional","affiliation":[{"name":"Indiana University Health, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Timmermann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Fertig","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1762-4736","authenticated-orcid":false,"given":"Eric","family":"Giza","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2912-8265","authenticated-orcid":false,"given":"Robert H.","family":"Brophy","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Washington University, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"Mandelbaum","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Cedars Sinai, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"McCullough","sequence":"additional","affiliation":[{"name":"Kansas City Orthopaedic Institute, Leawood, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117750825"},{"issue":"1","key":"e_1_3_2_3_2","first-page":"63","article-title":"Physical demands of different positions in FA Premier League soccer","volume":"6","author":"Bloomfield J","year":"2007","unstructured":"Bloomfield J, Polman R, O'Donoghue P. Physical demands of different positions in FA Premier League soccer. J Sports Sci Med. 2007;6(1):63-70.","journal-title":"J Sports Sci Med"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738111403107"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2022-001419"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510395879"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100666"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211024199"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671251360422"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671251360436"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671251399842"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100556"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07384-1"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002281-200103000-00009"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720969633"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.1997.tb00126.x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120966041"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509333012"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/6492597"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/jfmk8040155"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Pe\u010djak R Kozinc \u017d. Long-term deficits in muscle composition performance and quality of movement after Achilles tendon rupture: a review. BioMed. 2023;3(1):135-151. https:\/\/doi.org\/10.3390\/biomed3010012","DOI":"10.3390\/biomed3010012"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1123\/jab.2022-0088"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.3390\/jfmk8010022"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100713477621"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/jfmk5040095"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-025-00602-9"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118810772"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516685055"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465030310011801"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096106"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261449641","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671261449641","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261449641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:13:16Z","timestamp":1786536796000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671261449641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/23259671261449641"],"URL":"https:\/\/doi.org\/10.1177\/23259671261449641","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"article-number":"23259671261449641"}}