{"id":"https://openalex.org/W7223385372","doi":"https://doi.org/10.1177/23259671261488665","title":"Seasonal Clustering of Achilles Tendon Ruptures in the NFL: A 15-Year Analysis Revealing Preseason Vulnerability","display_name":"Seasonal Clustering of Achilles Tendon Ruptures in the NFL: A 15-Year Analysis Revealing Preseason Vulnerability","publication_year":2026,"publication_date":"2026-10-01","ids":{"openalex":"https://openalex.org/W7223385372","doi":"https://doi.org/10.1177/23259671261488665"},"language":"en","primary_location":{"id":"doi:10.1177/23259671261488665","doi":"https://doi.org/10.1177/23259671261488665","is_oa":true,"landing_page_url":"https://doi.org/10.1177/23259671261488665","pdf_url":null,"source":{"id":"https://openalex.org/S2755168269","display_name":"Orthopaedic Journal of Sports Medicine","issn_l":"2325-9671","issn":["2325-9671"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Orthopaedic Journal of Sports Medicine","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1177/23259671261488665","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5033551698","display_name":"Dustin J. Kress","orcid":"https://orcid.org/0000-0001-8129-5514","observed_orcids":["https://orcid.org/0000-0001-8129-5514"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Dustin J. Kress","raw_affiliation_strings":["Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA"],"raw_orcid":"https://orcid.org/0000-0001-8129-5514","affiliations":[{"raw_affiliation_string":"Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5091010946","display_name":"Patrick Waldron","orcid":"https://orcid.org/0009-0008-4981-2110","observed_orcids":["https://orcid.org/0009-0008-4981-2110"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Patrick Waldron","raw_affiliation_strings":["Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA"],"raw_orcid":"https://orcid.org/0009-0008-4981-2110","affiliations":[{"raw_affiliation_string":"Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5100554088","display_name":"David Han","orcid":"https://orcid.org/0009-0009-5089-2936","observed_orcids":["https://orcid.org/0009-0009-5089-2936"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"David Han","raw_affiliation_strings":["Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA"],"raw_orcid":"https://orcid.org/0009-0009-5089-2936","affiliations":[{"raw_affiliation_string":"Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5065553536","display_name":"Ajith Malige","orcid":"https://orcid.org/0000-0002-3984-4804","observed_orcids":["https://orcid.org/0000-0002-3984-4804"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ajith Malige","raw_affiliation_strings":["Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA"],"raw_orcid":"https://orcid.org/0000-0002-3984-4804","affiliations":[{"raw_affiliation_string":"Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5033551698"],"corresponding_institution_ids":[],"apc_list":{"value":1500,"currency":"USD","value_usd":1500},"apc_paid":{"value":1500,"currency":"USD","value_usd":1500},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.83272189,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"10","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11246","display_name":"Sports injuries and prevention","score":0.9491999745368958,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11246","display_name":"Sports injuries and prevention","score":0.9491999745368958,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11068","display_name":"Tendon Structure and Treatment","score":0.04500000178813934,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10455","display_name":"Foot and Ankle Surgery","score":0.0017999999690800905,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/achilles-tendon-rupture","display_name":"Achilles tendon rupture","score":0.9929999709129333},{"id":"https://openalex.org/keywords/national-football-league","display_name":"National Football League","score":0.7540000081062317},{"id":"https://openalex.org/keywords/professional-football-players","display_name":"professional football players","score":0.8190000057220459},{"id":"https://openalex.org/keywords/injury-prevention","display_name":"injury prevention","score":0.531000018119812},{"id":"https://openalex.org/keywords/return-to-sport","display_name":"return to sport","score":0.5899999737739563},{"id":"https://openalex.org/keywords/injury-epidemiology","display_name":"injury epidemiology","score":0.5049999952316284}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8359000086784363},{"id":"https://openalex.org/C2780984734","wikidata":"https://www.wikidata.org/wiki/Q223172","display_name":"Achilles tendon","level":3,"score":0.6225000023841858},{"id":"https://openalex.org/C2781317629","wikidata":"https://www.wikidata.org/wiki/Q340311","display_name":"Achilles tendon rupture","level":4,"score":0.5103999972343445},{"id":"https://openalex.org/C190385971","wikidata":"https://www.wikidata.org/wiki/Q373494","display_name":"Injury prevention","level":3,"score":0.5001000165939331},{"id":"https://openalex.org/C207456731","wikidata":"https://www.wikidata.org/wiki/Q660818","display_name":"League","level":2,"score":0.4957999885082245},{"id":"https://openalex.org/C3017944768","wikidata":"https://www.wikidata.org/wiki/Q1450463","display_name":"Poison control","level":2,"score":0.450300008058548},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.4397999942302704},{"id":"https://openalex.org/C2781054738","wikidata":"https://www.wikidata.org/wiki/Q4813730","display_name":"Athletes","level":2,"score":0.4357999861240387},{"id":"https://openalex.org/C2778444522","wikidata":"https://www.wikidata.org/wiki/Q1081491","display_name":"Football","level":2,"score":0.43059998750686646},{"id":"https://openalex.org/C2780105995","wikidata":"https://www.wikidata.org/wiki/Q232358","display_name":"Tendon","level":2,"score":0.40939998626708984},{"id":"https://openalex.org/C2778911562","wikidata":"https://www.wikidata.org/wiki/Q1682583","display_name":"Tendinopathy","level":3,"score":0.38040000200271606},{"id":"https://openalex.org/C187155963","wikidata":"https://www.wikidata.org/wiki/Q629029","display_name":"Occupational safety and health","level":2,"score":0.3743000030517578},{"id":"https://openalex.org/C2780610925","wikidata":"https://www.wikidata.org/wiki/Q6940405","display_name":"Musculoskeletal injury","level":3,"score":0.3720000088214874},{"id":"https://openalex.org/C43893838","wikidata":"https://www.wikidata.org/wiki/Q840545","display_name":"Sports medicine","level":2,"score":0.3474999964237213},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.3440000116825104},{"id":"https://openalex.org/C95713431","wikidata":"https://www.wikidata.org/wiki/Q631425","display_name":"Vulnerability (computing)","level":2,"score":0.3400999903678894},{"id":"https://openalex.org/C2988159620","wikidata":"https://www.wikidata.org/wiki/Q1311","display_name":"Winter season","level":2,"score":0.3366999924182892},{"id":"https://openalex.org/C99508421","wikidata":"https://www.wikidata.org/wiki/Q2678675","display_name":"Physical medicine and rehabilitation","level":1,"score":0.3301999866962433},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.29980000853538513},{"id":"https://openalex.org/C3017797855","wikidata":"https://www.wikidata.org/wiki/Q937857","display_name":"Football players","level":3,"score":0.29600000381469727},{"id":"https://openalex.org/C526869908","wikidata":"https://www.wikidata.org/wiki/Q3298118","display_name":"Suicide prevention","level":3,"score":0.28349998593330383},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.26669999957084656},{"id":"https://openalex.org/C166735990","wikidata":"https://www.wikidata.org/wiki/Q1750812","display_name":"Human factors and ergonomics","level":3,"score":0.26100000739097595},{"id":"https://openalex.org/C85004164","wikidata":"https://www.wikidata.org/wiki/Q1089964","display_name":"Injury Severity Score","level":4,"score":0.25920000672340393},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.2556000053882599}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1177/23259671261488665","doi":"https://doi.org/10.1177/23259671261488665","is_oa":true,"landing_page_url":"https://doi.org/10.1177/23259671261488665","pdf_url":null,"source":{"id":"https://openalex.org/S2755168269","display_name":"Orthopaedic Journal of Sports Medicine","issn_l":"2325-9671","issn":["2325-9671"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Orthopaedic Journal of Sports Medicine","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:ec07bc742f964dce8592a6f29baf8c78","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/ec07bc742f964dce8592a6f29baf8c78","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Orthopaedic Journal of Sports Medicine, Vol 14 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1177/23259671261488665","doi":"https://doi.org/10.1177/23259671261488665","is_oa":true,"landing_page_url":"https://doi.org/10.1177/23259671261488665","pdf_url":null,"source":{"id":"https://openalex.org/S2755168269","display_name":"Orthopaedic Journal of Sports Medicine","issn_l":"2325-9671","issn":["2325-9671"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Orthopaedic Journal of Sports Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9763000011444092}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":30,"referenced_works":["https://openalex.org/W1994042551","https://openalex.org/W2037054699","https://openalex.org/W2068700359","https://openalex.org/W2098271124","https://openalex.org/W2163637305","https://openalex.org/W2168060324","https://openalex.org/W2438438753","https://openalex.org/W2586949072","https://openalex.org/W2626890426","https://openalex.org/W2661850965","https://openalex.org/W2736935801","https://openalex.org/W2901470200","https://openalex.org/W2948321121","https://openalex.org/W3029310387","https://openalex.org/W3042872557","https://openalex.org/W3099150361","https://openalex.org/W3112799399","https://openalex.org/W3140172557","https://openalex.org/W3155611599","https://openalex.org/W3158104706","https://openalex.org/W4221049511","https://openalex.org/W4288443592","https://openalex.org/W4303696464","https://openalex.org/W4316589881","https://openalex.org/W4319461559","https://openalex.org/W4361205100","https://openalex.org/W4378952863","https://openalex.org/W4386910920","https://openalex.org/W4387665287","https://openalex.org/W4399907525"],"related_works":["https://openalex.org/W7204843381","https://openalex.org/W4200622972","https://openalex.org/W7168491432","https://openalex.org/W2626890426","https://openalex.org/W4233823236","https://openalex.org/W7204760323","https://openalex.org/W2805173602","https://openalex.org/W2982327966","https://openalex.org/W4316589881","https://openalex.org/W7116880153"],"abstract_inverted_index":{"Background:":[0],"Achilles":[1,46,72,181,271,327],"tendon":[2,47,73,182,272],"ruptures":[3,48,74,183,273],"remain":[4],"devastating":[5],"injuries":[6,24,197,212,235,302],"in":[7,59,75,258,274,288,330],"professional":[8],"football.":[9],"While":[10],"return-to-play":[11],"rates":[12,150,261],"and":[13,52,92,118,129,141,143,157,171,217,281,291,321],"postinjury":[14],"outcomes":[15],"are":[16],"well":[17],"documented,":[18],"the":[19,26,43,102,152,158,168,172,191,206,279,294],"temporal":[20],"distribution":[21,44],"of":[22,45,55,147,179,224,300],"these":[23,289],"throughout":[25],"National":[27],"Football":[28],"League":[29],"(NFL)":[30],"season":[31,50,103,111,208,220,229],"has":[32],"not":[33,253],"been":[34],"systematically":[35],"evaluated.":[36],"Purpose:":[37],"The":[38,248],"purpose":[39],"was":[40],"to":[41,64,80,325],"evaluate":[42],"across":[49],"phases":[51],"identify":[53,310],"periods":[54,290],"elevated":[56],"injury":[57,149,193,203,260],"risk":[58],"NFL":[60,76,275],"players":[61,77,276],"from":[62,78,255],"2010":[63,79],"2024.":[65],"Study":[66],"Design:":[67],"Descriptive":[68],"epidemiology":[69],"study.":[70],"Methods:":[71],"2024":[81],"were":[82,96,165,184],"identified":[83,185],"using":[84,104,167],"publicly":[85],"available":[86],"data,":[87],"including":[88],"Pro":[89],"Sports":[90],"Transactions":[91],"team-specific":[93],"reports.":[94],"Injuries":[95],"stratified":[97],"based":[98],"on":[99],"timing":[100],"within":[101],"4":[105,306],"analyses:":[106],"(1)":[107],"a":[108,123,145,200],"3-phase":[109],"regular":[110,207,219,228,283],"model\u2014early":[112],"(weeks":[113,116,120,127,132],"1-5),":[114],"mid":[115],"6-10),":[117],"late":[119],"11-17);":[121],"(2)":[122],"2-phase":[124],"model\u2014first":[125],"half":[126,131],"1-8)":[128],"second":[130],"9-17);":[133],"(3)":[134],"an":[135],"extended-season":[136],"analysis":[137,241],"incorporating":[138],"offseason,":[139],"preseason,":[140],"postseason;":[142],"(4)":[144],"comparison":[146,230],"postseason":[148,259],"between":[151],"pre-Week":[153],"18":[154,160,250],"era":[155,161,251],"(2010-2020)":[156],"Week":[159,249],"(2021-2024).":[162],"Injury":[163],"frequencies":[164],"compared":[166],"chi-square":[169],"test":[170],"Fisher":[173],"exact":[174],"test.":[175],"Results:":[176],"A":[177],"total":[178],"253":[180],"over":[186],"15":[187],"years.":[188],"Preseason":[189],"demonstrated":[190,242,269],"highest":[192],"burden":[194,329],"with":[195,285],"85":[196],"(33.6%),":[198],"representing":[199,293],"3.0-fold":[201],"higher":[202],"density":[204],"than":[205],"(21.3":[209],"vs":[210],"7.1":[211],"per":[213],"week).":[214],"Combined":[215],"preseason":[216,280,292,318],"early":[218,282],"accounted":[221],"for":[222,298,314],"62.1%":[223,286],"all":[225,301],"ruptures.":[226],"Two-phase":[227],"showed":[231],"significantly":[232],"more":[233],"first-half":[234],"(":[236,244,262],"P":[237,245,263],"=":[238],".03).":[239],"Extended-season":[240],"significance":[243],"<":[246],".01).":[247],"did":[252],"differ":[254],"earlier":[256],"seasons":[257],">":[264],".99).":[265],"Conclusion:":[266],"Our":[267],"study":[268],"that":[270],"cluster":[277],"during":[278],"season,":[284],"occurring":[287],"highest-risk":[295],"phase,":[296],"accounting":[297],"one-third":[299],"despite":[303],"lasting":[304],"only":[305],"weeks.":[307],"These":[308],"findings":[309],"critical":[311],"vulnerability":[312],"windows":[313],"targeted":[315],"injury-prevention":[316],"strategies,":[317],"conditioning":[319],"protocols,":[320],"player":[322],"load":[323],"management":[324],"reduce":[326],"rupture":[328],"elite":[331],"football":[332],"athletes.":[333]},"counts_by_year":[],"updated_date":"2026-10-26T11:51:55.731654","created_date":"2026-10-24T00:00:00"}
