Thursday , March 06, 2014 - 12:20 PM
A decade ago, an Achilles’ tendon tear was a diagnosis that made NFL team doctors shudder.
It typically meant an arduous, year-long recovery, and even then, there was a one-in-three chance the patient never would play again.
The Achilles’ tear that San Francisco 49ers wide receiver Michael Crabtree suffered last month still is serious, and his recovery remains long and difficult. But advances in how doctors repair the tear, as well as a more aggressive rehabilitation protocol, have improved his chances of coming back more quickly and with better strength than if he had suffered it just a few years ago.
Dr. Robert Anderson, who is the NFL’s foremost foot and ankle specialist, operated on Crabtree’s fractured left foot before the 2009 draft.
Anderson said it once took nine to 12 months for a player to recover from an Achilles’ injury. Today, that time frame is down to six to nine months. In fact, Anderson noted that Ravens linebacker Terrell Suggs was back on the field 5 1/2 months after partially tearing his Achilles’ last year.
‘‘What we’re seeing, at least anecdotally, is that these guys are making it back quicker and with better strength characteristics,” said Anderson.
The advances in Achilles’ treatment are threefold, beginning with the surgery itself.
Years ago, doctors would make an incision along the tendon -- 6 to 8 inches long -- and suture the entire length to ensure the damaged area remained intact.
Today, the incision can be only 2 centimeters long, with fine but ultra-strong sutures used to repair the tear.
University of California, Davis’ Dr. Eric Giza, one of the orthopedic surgeons for the U.S. Soccer Federation, said the minimally invasive approach preserves as much tissue around the Achilles’ as possible, thereby allowing it to heal better and faster.
The smaller incision means less scarring and a lower chance of infection, “which in the case of a professional athlete probably would lead to the end of their career,” Giza said.
A tiny wound also doesn’t take as long to heal, which allows rehabilitation to begin much sooner than before.
It used to be that Achilles’ patients would be in a cast for six weeks after surgery, which caused the calf muscle to atrophy and led to a longer recovery.
Now a patient is in a walking boot two weeks following the procedure. At six weeks -- about where Crabtree is now -- he might be able to put weight on the foot for the first time.
‘‘Every tear is a little different,” said Dr. Dan Solomon, an orthopedic surgeon with Marin Orthopedics and Sports Medicine in Novato, “but you try to get as aggressive as you can with the recovery.”
Finally, an elite athlete like Crabtree is aided by cutting-edge medical procedures.
One of the reasons Achilles’ tears can take so long to heal -- indeed why the tendon rips in the first place -- is blood flow is poor in that area.
With someone like Crabtree or Lakers star Kobe Bryant, who tore his Achilles’ in April, doctors typically use platelet-rich plasma (PRP) to speed healing.
A small amount of blood taken from the patient is “spun down” in a centrifuge so the platelet cells, which help form blood clots, are isolated. They are then applied to the wound in the hope that it stimulates healing.
Giza said he uses PRP on two disparate groups -- patients who need the extra help, such as diabetics, and elite athletes.
‘‘Because they are going to put more demand on that tendon than the average person,” Giza said. “And because this is all the marbles for them. If they don’t get back, they don’t eat.”
Use of PRP is controversial in the medical community, not because it is harmful, but because no large-scale studies have proven it’s effective. Solomon, however, said he has seen positive results.
‘‘My take is that it works,” he said. “It may not work on every single patient. But it works better than nothing.”
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