{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:29:55Z","timestamp":1787574595908,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Achilles tendon ruptures are among the most common sports injuries. The literature reports highly variable \u201creturn to sport\u201d (RTS) rates depending on the study, as the definition of return to play is not consistent. Our purpose was to assess RTS and self-reported relative performance level after surgical management of acute Achilles tendon ruptures. Method: In this retrospective analysis of a prospective cohort, the RTS rate and the return to self-reported preinjury level (RTPIL) in patients treated surgically for acute Achilles tendon rupture between November 2020 and September 2023 with at least 2 years of follow-up were reported. The primary outcomes were the RTS and RTPIL rates at last follow-up. Secondary outcomes were Patient-Reported Outcome Measures (PROMS): Achilles Tendon Total Rupture Score (ATRS), Ankle Ligament Reconstruction\u2013Return to Sport after Injury (ALR-RSI), Foot and Ankle Ability Measure (FAAM), Tegner Activity Scale (TAS) and the University of California and Los Angeles (UCLA) activity level rating scale. Data was collected preoperatively; at three, six, twelve, and twenty-four months postoperatively; and then every two months thereafter. Kaplan\u2013Meier analysis was performed to measure time to RTS and RTPIL. Results: In the final analysis, 65 patients were included for analysis of RTS and RTPIL, and 69 for the PROMS. In total, 81.7% (58) were male, and the mean age was 40.6 years (SD 12.5). The RTS rate was 76.9%, and the RTPIL rate was 44.6%. The mean delay to RTS was 11.6 months (SD 7.6). The median time to RTS was approximately 14 months (95% CI, 10.0\u201318.0). The RTPIL rate continued to increase between the first and second years after surgery. At the last follow-up, the median ATRS was 89 with an interquartile range (IQR) of [77.0\u201395.0], ALR-RSI was 80 [62.5\u201395.0], FAAM activity was 91.7 [85.7\u201397.6], FAAM sport was 85.9 [68.8\u201396.9], TAS was 7 [5\u20137], and UCLA was 10 [9\u201310]. Median follow-up was 24.8 months. Conclusions: In conclusion, self-reporting of RTS and RTPIL yields low rates, and caution should be used in overly optimistic preoperative counselling. Level of evidence: IV.<\/jats:p>","DOI":"10.3390\/jcm15176512","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"6512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Return to Sport and Return to Self-Reported Preinjury Level After Surgical Repair of Acute Achilles Tendon Rupture: A 2-Year Prospective Cohort Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5864-0084","authenticated-orcid":false,"given":"Maxime","family":"Guerot","sequence":"first","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Khiami","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eug\u00e9nie","family":"Valentin","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Grimaud","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2611-3938","authenticated-orcid":false,"given":"Mohamad K.","family":"Moussa","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Gerometta","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Meyer","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Lef\u00e8vre","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1604-8194","authenticated-orcid":false,"given":"Alexandre","family":"Hardy","sequence":"additional","affiliation":[{"name":"Clinique du Sport, Groupe Chirurgie du Sport, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3396","DOI":"10.1177\/03635465241284644","article-title":"Epidemiology of Sports-Related Tendon Ruptures Presenting to Emergency Departments in the United States","volume":"52","author":"Lyons","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fraser, J.J., Zellers, J.A., Sullivan, C.K., and Janney, C.F. (2024). Prevalence and Risk Factors for Achilles Tendon Rupture in the Military Population from 2006 to 2015: A Retrospective Cohort Study. BMJ Mil. Health, 171.","DOI":"10.1101\/2023.10.02.23296425"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3109\/17453679608994688","article-title":"Incidence of Achilles Tendon Rupture","volume":"67","author":"Leppilahti","year":"1996","journal-title":"Acta Orthop. Scand."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/00042752-199907000-00007","article-title":"Changing Incidence of Achilles Tendon Rupture in Scotland: A 15-Year Study","volume":"9","author":"Maffulli","year":"1999","journal-title":"Clin. J. Sport Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Briggs-Price, S., Mangwani, J., Houchen-Wolloff, L., Modha, G., Fitzpatrick, E., Faizi, M., Shepherd, J., and O\u2019Neill, S. (2024). Incidence, Demographics, Characteristics and Management of Acute Achilles Tendon Rupture: An Epidemiological Study. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0304197"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Leino, O., Keskinen, H., Laaksonen, I., M\u00e4kel\u00e4, K., L\u00f6yttyniemi, E., and Ekman, E. (2022). Incidence and Treatment Trends of Achilles Tendon Ruptures in Finland: A Nationwide Study. Orthop. J. Sports Med., 10.","DOI":"10.1177\/23259671221131536"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s40279-026-02397-5","article-title":"Incidence, Temporal Trends, and Surgical Shift of Achilles Tendon Rupture: A Systematic Review and Meta-Analysis","volume":"56","author":"Kotsifaki","year":"2026","journal-title":"Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/S0020-1383(98)00147-8","article-title":"The Epidemiology of Achilles Tendon Rupture in a Danish County","volume":"29","author":"Houshian","year":"1998","journal-title":"Injury"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1053\/j.jfas.2024.04.005","article-title":"Gender Differences in Achilles Tendon Ruptures\u2014A Retrospective Study and a Review of the Literature","volume":"63","author":"Hartman","year":"2024","journal-title":"J. Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Meadows, K., Ye, F., Qiu, A., Iyawe, O., and Kenneth-Nwosa, K. (2024). Economic and Performance Analysis of Achilles Tendon Rupture in the National Basketball Association. Orthop. J. Sports Med., 12.","DOI":"10.1177\/23259671241279388"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s12178-022-09774-3","article-title":"Achilles Tendon Ruptures and Repair in Athletes\u2014A Review of Sports-Related Achilles Injuries and Return to Play","volume":"15","author":"Mansfield","year":"2022","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.2106\/JBJS.O.00002","article-title":"Everything Achilles: Knowledge Update and Current Concepts in Management: AAOS Exhibit Selection","volume":"97","author":"Uquillas","year":"2015","journal-title":"J. Bone Jt. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"310","DOI":"10.32098\/mltj.03.2018.03","article-title":"I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines","volume":"08","author":"Oliva","year":"2019","journal-title":"Muscle Ligaments Tendons J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.fcl.2019.04.003","article-title":"Maximizing Return to Sports After Achilles Tendon Rupture in Athletes","volume":"24","author":"Caldwell","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1053\/j.jfas.2017.05.036","article-title":"Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"56","author":"Deng","year":"2017","journal-title":"J. Foot Ankle Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1080\/00913847.2021.1932634","article-title":"Return to Play, Performance, and Value of National Basketball Association Players Following Achilles Tendon Rupture","volume":"49","author":"Chauhan","year":"2021","journal-title":"Physician Sportsmed."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1177\/1071100717718131","article-title":"Performance and Return to Sport After Achilles Tendon Repair in National Football League Players","volume":"38","author":"Jack","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1177\/1071100720969633","article-title":"Career Outlook and Performance of Professional Athletes After Achilles Tendon Rupture: A Systematic Review","volume":"42","author":"Johns","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1136\/bjsports-2021-104835","article-title":"Return-to-Play and Performance after Operative Treatment of Achilles Tendon Rupture in Elite Male Athletes: A Scoping Review","volume":"56","author":"LaPrade","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tarantino, D., Palermi, S., Sirico, F., and Corrado, B. (2020). Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. J. Funct. Morphol. Kinesiol., 5.","DOI":"10.3390\/jfmk5040095"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1136\/bjsports-2016-096106","article-title":"Return to Play Post-Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Rate and Measures of Return to Play","volume":"50","author":"Zellers","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.jfas.2023.12.008","article-title":"Return to Play and Functional Outcomes Following Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis","volume":"63","author":"Bak","year":"2024","journal-title":"J. Foot Ankle Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/1071100720919029","article-title":"Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture","volume":"41","author":"Lerch","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2022.0239","article-title":"Return to Sport after Surgical Repair of the Achilles Tendon","volume":"84","author":"Vaidya","year":"2023","journal-title":"Br. J. Hosp. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Miller, T.L., and Welder, E. (2021). Achilles Tendon Repair with Modified Giftbox Technique Using Nonabsorbable Suture Loops. Video J. Sports Med., 1.","DOI":"10.1177\/2635025421992782"},{"key":"ref_26","first-page":"49","article-title":"The Achilles Tendon Resting Angle as an Indirect Measure of Achilles Tendon Length Following Rupture, Repair, and Rehabilitation","volume":"2","author":"Carmont","year":"2015","journal-title":"Asia-Pac. J. Sports Med. Arthrosc. Rehabil. Technol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00003086-198509000-00007","article-title":"Rating Systems in the Evaluation of Knee Ligament Injuries","volume":"198","author":"Tegner","year":"1985","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"228","DOI":"10.2106\/00004623-198466020-00010","article-title":"Treatment of Primary Osteoarthritis of the Hip. A Comparison of Total Joint and Surface Replacement Arthroplasty","volume":"66","author":"Amstutz","year":"1984","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S0883-5403(98)90195-4","article-title":"Assessing Activity in Joint Replacement Patients","volume":"13","author":"Zahiri","year":"1998","journal-title":"J. Arthroplast."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/0363546506294856","article-title":"The Achilles Tendon Total Rupture Score (ATRS): Development and Validation","volume":"35","author":"Silbernagel","year":"2007","journal-title":"Am. J. Sports Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S0140-6736(19)32942-3","article-title":"Plaster Cast versus Functional Brace for Non-Surgical Treatment of Achilles Tendon Rupture (UKSTAR): A Multicentre Randomised Controlled Trial and Economic Evaluation","volume":"395","author":"Costa","year":"2020","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1186\/s13018-025-05748-6","article-title":"Functional Outcomes Following Minimally Invasive Achilles Rupture Repair: A Retrospective Comparative Study of PARS and Midsubstance Speedbridge Techniques","volume":"20","author":"Peabody","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Westin, O., Sj\u00f6gren, T., Svedman, S., Horvath, A., Hamrin Senorski, E., Samuelsson, K., and Ackermann, P. (2020). Treatment of Acute Achilles Tendon Rupture\u2014A Multicentre, Non-Inferiority Analysis. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03320-3"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.fas.2019.08.010","article-title":"French Translation and Validation of the Achilles Tendon Total Rupture Score \u201cATRS.\u201d","volume":"26","author":"Buckinx","year":"2020","journal-title":"Foot Ankle Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4961","DOI":"10.1007\/s00167-023-07548-z","article-title":"The ALR-RSI Score Can Be Used to Evaluate Psychological Readiness to Return to Sport after Acute Achilles Tendon Tear","volume":"31","author":"Shitrit","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1177\/107110070502601113","article-title":"Evidence of Validity for the Foot and Ankle Ability Measure (FAAM)","volume":"26","author":"Martin","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Picot, B., Hardy, A., Terrier, R., Tassignon, B., Lopes, R., and Fourchet, F. (2022). Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients with Chronic Ankle Instability? A Narrative Review and Expert Opinion. Front. Sports Act. Living, 4.","DOI":"10.3389\/fspor.2022.902886"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Cofano, E., Colace, S., Piro, F., Longo, U.G., D\u2019Hooghe, P., Kennedy, J.G., Marangon, A., SIAGASCOT, Gasparini, G., and Mercurio, M. (2025). Successful Functional Outcomes and Return to Sport Rate Can Be Achieved after Surgery for Acute Achilles Tendon Rupture: A Systematic Review. J. Exp. Orthop., 12.","DOI":"10.1002\/jeo2.70469"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Yang, J., Hodax, J.D., Machan, J.T., Krill, M.K., Lemme, N.J., Durand, W.M., Hoffman, J.T., Hewett, T.E., and Owens, B.D. (2019). Factors Affecting Return to Play After Primary Achilles Tendon Tear: A Cohort of NFL Players. Orthop. J. Sports Med., 7.","DOI":"10.1177\/2325967119830139"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00167-011-1511-3","article-title":"Major Functional Deficits Persist 2 Years after Acute Achilles Tendon Rupture","volume":"19","author":"Olsson","year":"2011","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1177\/03635465251333142","article-title":"Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair","volume":"53","author":"Lopes","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1186\/s13018-025-06019-0","article-title":"Open Surgery and Minimally Invasive Repair of Acute Achilles Tendon Rupture: Stratified Outcomes Based on Immobilization Duration in a Prospective Cohort Study","volume":"20","author":"Cao","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00264-024-06362-7","article-title":"Mini-Open versus Percutaneous Surgical Repair for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis","volume":"49","author":"Melinte","year":"2025","journal-title":"Int. Orthop. (SICOT)"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ochen, Y., Beks, R.B., Van Heijl, M., Hietbrink, F., Leenen, L.P.H., Van Der Velde, D., Heng, M., Van Der Meijden, O., Groenwold, R.H.H., and Houwert, R.M. (2019). Operative Treatment versus Nonoperative Treatment of Achilles Tendon Ruptures: Systematic Review and Meta-Analysis. BMJ, 364.","DOI":"10.1136\/bmj.k5120"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/sms.12415","article-title":"A Chilles Tendon Rupture\u2014Treatment and Complications: A Systematic Review","volume":"25","author":"Holm","year":"2015","journal-title":"Scand. Med. Sci. Sports"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1177\/0363546518824601","article-title":"Complications in the Management of Acute Achilles Tendon Rupture: A Systematic Review and Network Meta-Analysis of 2060 Patients","volume":"47","author":"Wu","year":"2019","journal-title":"Am. J. Sports Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:08:16Z","timestamp":1787573296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":46,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176512"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176512","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]}}}