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Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play
  1. Jennifer A Zellers1,
  2. Michael R Carmont2,3,
  3. Karin Grävare Silbernagel3,4
  1. 1Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
  2. 2Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK
  3. 3Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
  1. Correspondence to Dr Karin Grävare Silbernagel, Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE 19713, USA; kgs{at}


Aim This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP.

Design A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination.

Data sources PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles.

Eligibility criteria for selecting studies Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included.

Results 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001).

Conclusions 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.

  • Achilles
  • Sport
  • Physical activity
  • Achilles tendon
  • Assessment

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  • Contributors JAZ was one of the primary drafters of the manuscript, performed article review, data extraction and data analysis. MRC was one of the primary drafters of the manuscript, developed study concept and performed article review and data extraction. KGS developed study concept and research design, assisted in article review, data extraction and data analysis and provided critical feedback of the manuscript.

  • Funding This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institute of Health under awards R21 AR067390 and the University of Delaware Research Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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