Pickleball and the Return to Sport After Achilles Tendon Rupture

Research Type: Level 4 – Case series Introduction/Purpose: Pickleball is one of the fastest growing sports in the United States. With its rising popularity, particularly in the aging population, comes concern for potential injuries that previously rarely affected this patient cohort. The purpose of this study was to investigate clinical outcomes and return to sport after acute Achilles tendon rupture in this unique patient population. Methods: A retrospective analysis was performed of patients who sustained an acute Achilles tendon rupture while playing pickleball. A database search of all Achilles tendon ruptures (ICD-10 S86.0) presenting to a large, multistate, subspecialty referral orthopaedic clinic between January 2013 and June 2023 were identified and included in the study. Patients were contacted via telephone to confirm mechanism and collect data regarding length of time playing pickleball prior to injury, return to sport following injury, and Achilles Tendon Rupture Score (ATRS). Results: Of 42 identified patients with pickleball-related Achilles ruptures between January 2013 and June 2023, 28 (67%) were contacted and included. Mean age was 63.9 years, and mean BMI was 27.3. Most injuries (68%) occurred within the first month of playing, with 32% on the first day. Sixty percent of patients were treated surgically. At a mean follow-up of 4.7 years, the mean ATRS was 94.6, with no significant difference between operative and nonoperative groups (93.0 vs 97.0, p = 0.26). Only 47% returned to pickleball, with fear of reinjury cited as the primary reason for not returning. Average time to return was 1.6 years, with no significant difference by treatment (p = 0.52). Conclusion: The rising popularity of pickleball and its associated injuries poses a significant risk to the aging population. Despite favorable long term outcomes regardless of treatment modality, nearly half of patients who sustain an Achilles tendon injury from pickleball do not return to playing, most commonly out of fear of reinjury.