Pickleball and the Return to Sport After Achilles Tendon Rupture

INTRODUCTION: 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. The purpose of this study was to investigate clinical outcomes and return to sport (RTS) 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 from 2013 to 2023. Patients were contacted through telephone to confirm mechanism and collect data regarding length of time playing pickleball before injury, RTS following injury, and Achilles Tendon Rupture Score (ATRS). RESULTS: A total of 42 patients who suffered an Achilles tendon rupture were identified, of whom 28 were able to be contacted and included in this study, with a response rate of 67%. The average age of patients who sustained a pickleball-associated Achilles tendon rupture was 63.9 (36 to 81) years. Sixty-eight percent of patients reported sustaining the injury within the 1st month of playing pickleball, with 32% playing for the first time. At a mean follow-up of 4.7 years, no significant differences were observed in ATRS or the rate of RTS between patients surgically and nonsurgically. The overall rate of RTS was 47% at an average of 1.6 years. All but one patient who did not RTS stated a fear of reinjury as their reasoning. CONCLUSION: The rising popularity of pickleball poses a notable risk to the aging population because of its associated injuries. Despite favorable long-term outcomes regardless of treatment modality, over half of patients who sustain an Achilles tendon injury from pickleball do not return to playing, most commonly out of fear of reinjury. LEVEL OF EVIDENCE: IV; retrospective case series.