{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:34:25Z","timestamp":1777613665082,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"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":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pickleball has emerged as the fastest-growing sport in the United States, with participation increasing nearly 1000% since 2019 and now surpassing 36\u2009million players. Within the same period, tennis participation has risen by 33%. Pickleball\u2019s rapid rise, accelerated by the COVID-19 pandemic, has paralleled anecdotal reports of musculoskeletal injury, yet little is known regarding Achilles tendon rupture (ATR) risk in this population. Tennis, a sport with similar biomechanics, has long been studied in relation to ATR, but comparative data for pickleball is lacking. The purpose of this study is to compare ATR proportional frequency sustained during pickleball, tennis, and all other sports to identify patterns of risk and inform athlete counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A retrospective review was conducted from January 2018 through December 2022 to identify patients who underwent Achilles tendon repairs within a large, independent orthopaedic group (&gt;100 surgeons). Procedures were identified through the\n                      <jats:italic toggle=\"yes\">Current Procedural Terminology<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">CPT<\/jats:italic>\n                      ) code 27650. Patients aged 18-75\u2009years with acute ATR who were treated operatively were included. Exclusion criteria were chronic tears requiring graft augmentation, revision procedures, failed nonoperative management, &lt;2\u2009months of follow-up, or incomplete clinical documentation. Mechanism of injury was recorded and categorized as pickleball, tennis, or other sports. A total of 1035 ATRs were identified and reviewed, with 1028 patients undergoing operative repair of an acute ATR. This included 942 other sports, 46 tennis, and 40 pickleball injuries. The primary outcome was the percentage of surgical volume of pickleball-related ATRs compared with tennis and other sports, stratified by age and year of injury. Secondary outcomes included major complications and minor complications. Data were analyzed using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \/Fisher exact tests and Wilcoxon rank-sum tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Pickleball ATRs occurred in significantly older patients (median 60\u2009years) compared with tennis (45\u2009years) and other sports (37\u2009years) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001). The sex distribution and comorbidities were similar across groups. BMI was lower in tennis and pickleball vs other sports (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.0004). Age distribution demonstrated that 82.5% of pickleball ruptures occurred in patients &gt;50\u2009years vs 32.6% in tennis and 18.9% in other sports. Pickleball-related ATRs increased from 0.5% in 2018 to 6.7% in 2021. There was no difference in complication rates between patients with pickleball-related ATRs and all other sports (15.0% vs 15.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pickleball-associated Achilles tendon ruptures represent a distinct demographic pattern, predominantly affecting adults &gt;50\u2009years of age, with a marked increase in cases following 2020, suggesting a correlation with the start of the COVID-19 pandemic. With the numbers available, no significant difference in postoperative complication rates was detected; however, the relatively small number of pickleball injuries limits statistical power and precludes definitive conclusions regarding comparative safety or injury patterns compared with tennis or other sports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114261425665","type":"journal-article","created":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T14:47:41Z","timestamp":1773586061000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pickleball-Associated Achilles Tendon Ruptures: Shifting Achilles Repair Demographics"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0929-1077","authenticated-orcid":false,"given":"James H.","family":"Padley","sequence":"first","affiliation":[{"name":"OrthoCarolina Research Institute Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5742-685X","authenticated-orcid":false,"given":"Benjamin","family":"Averkamp","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0161-2211","authenticated-orcid":false,"given":"Madeline","family":"Rieker","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-4408","authenticated-orcid":false,"given":"Tyler","family":"Kalbac","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher D.","family":"Murawski","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James A.","family":"Lendrum","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-5546","authenticated-orcid":false,"given":"Justin","family":"Rennard","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9918-373X","authenticated-orcid":false,"given":"Andrew","family":"Rees","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4852-5450","authenticated-orcid":false,"given":"Kayla","family":"Hietpas","sequence":"additional","affiliation":[{"name":"OrthoCarolina Research Institute Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carroll P.","family":"Jones","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-5618","authenticated-orcid":false,"given":"Todd A.","family":"Irwin","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2489-3267","authenticated-orcid":false,"given":"Scott B.","family":"Shawen","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Kent","family":"Ellington","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8367-9941","authenticated-orcid":false,"given":"Samuel E.","family":"Ford","sequence":"additional","affiliation":[{"name":"OrthoCarolina Division of Foot and Ankle, Charlotte, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Tammaro P. Pickleball statistics: America\u2019s fastest growing sport in 2023. RSS. Accessed August 24 2023. https:\/\/www.thepickleballdinks.com\/post\/pickleball-statistics"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2019.09.016"},{"key":"e_1_3_2_4_2","unstructured":"Tyler W. Pickleball popularity statistics and demographics: facts & infographic. The Pickleball Player. Published 2023. Accessed August 26 2025. https:\/\/thepickleballplayer.com\/pickleball-popularity-statistics-demographics-infographic\/"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.08.050"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.04.007"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.30827\/Digibug.76979"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1249\/jsr.0000000000000966"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jisako.2022.10.002"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011424S00469"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967114549948"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2022.03.006"},{"key":"e_1_3_2_15_2","unstructured":"USA Pickleball Association. 2023 USA pickleball fact sheet. USA Pickleball 2023. Accessed November 10 2025. https:\/\/kesq.b-cdn.net\/2023\/07\/gS9d7D2E-USA-Pickleball-Fact-Sheet-2023.pdf"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2022.819576"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00072.2022"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2017.06.009"}],"container-title":["Foot &amp; Ankle Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114261425665","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24730114261425665","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114261425665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:26:38Z","timestamp":1777411598000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24730114261425665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/24730114261425665"],"URL":"https:\/\/doi.org\/10.1177\/24730114261425665","relation":{},"ISSN":["2473-0114","2473-0114"],"issn-type":[{"value":"2473-0114","type":"print"},{"value":"2473-0114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"24730114261425665"}}