Video Analysis of Achilles Tendon Ruptures in the National Football League: Situational Patterns, Injury Mechanisms, and Paths for Injury Prevention

BACKGROUND: Achilles tendon ruptures (ATRs) are rare but severe injuries for players in the National Football League (NFL). Systematic video analysis of these injuries, combined with player tracking data and epidemiological analysis, can provide critical insight into the circumstances surrounding ATRs in the NFL and inform potential injury mitigation strategies. PURPOSE: To characterize the injury scenarios and situational patterns associated with ATRs in the NFL through a retrospective review of all in-game ruptures over 7 seasons. STUDY DESIGN: Descriptive epidemiology study. METHODS: All ATRs from 7 seasons (2018-2024) of NFL games were identified through the NFL's league-wide electronic medical records and reviewed to identify the time of injury, player-to-player contact, and injury scenario. These data were integrated with player and game information to evaluate injury rates across player characteristics and game variables. Time-aligned player tracking metrics, including speed and direction of motion, were also calculated to evaluate player movements at the time of injury. RESULTS: A total of 77 ATRs occurred during NFL games from 2018 to 2024. These were primarily noncontact (64%) or indirect contact (35%) injuries that occurred at relatively low translational player speeds. Overall, 3 primary injury scenarios accounted for 97% of ATRs: change of direction (40%), overload (30%), and rock back (27%). Players typically had a similar body position at the time of injury. In most cases, the injured leg was extended behind the body, with the ankle dorsiflexed and the hip and knee extended. Defensive players and those with >3 years of NFL experience had a higher injury rate. CONCLUSION: This study presents a comprehensive analysis of how ATRs occur in NFL games. The relatively low player speeds and predominantly noncontact nature of these injuries indicate that the high tendon loads that contribute to rupture are likely driven by player body positioning and propulsive push-off mechanics. Interventions that target high-risk player movement patterns could be effective injury prevention strategies, especially for rock back injury scenarios in which player motion appears to be more of a planned movement strategy rather than a reaction.