Aaron Rodgerss Achilles recovery sparks worry, intrigue among doctors
Anikar Chhabra has become friends with several NFL team doctors during decades working in sports medicine, and their conversations this year have often turned to quarterback Aaron Rodgers. As they watched and discussed Rodgers’s attempt to return from an Achilles’ tendon tear with unprecedented speed, one conclusion emerged: Rodgers’s actions were too risky and had the potential to endanger not only himself but other athletes.
“Not one of [the team doctors] thought it was a good idea for him to come back,” said Chhabra, the chair of sports medicine at the Mayo Clinic in Arizona and Arizona State’s medical director since 2007. “They laughed it off and said, ‘Gosh, I’d hate to be the Jets’ doc right now because he’s in a no-win situation.’ It’s the same response you get from everybody: He’s crazy. He’s going to have some long-term difficulties if he retears. If he gets away with it, it’s going to set a horrible precedent. Nobody has said anything different from that of all the people I’ve talked to.”
On the opening Monday night of the season, after he took his fourth snap as a New York Jet, Rodgers hobbled onto a motorized cart with a shredded left Achilles’ tendon. The despondence at MetLife Stadium came with an assumption built on the entire recorded history of the injury in the NFL: Rodgers’s season had ended. Recovery typically takes between six and nine months, and it had never been condensed into less than a full NFL season.
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Rodgers vowed he could defy the traditional timeline, and on Wednesday the Jets opened a 21-day window during which Rodgers can practice while they decide whether to activate him off injured reserve. That leaves open a possibility that has garnered attention across the league and in the sports medicine community: Rodgers says he might play this year, less than four months after he tore his Achilles’.
The aggressive approach raises an obvious question: Is this a good idea? Opinion among doctors is not uniform. For some, that framing oversimplifies the calculation Rodgers and the Jets are making. There’s no debate Rodgers would push the boundaries of Achilles’ tendon tear recovery and take on additional risk if he were to play. But given his individual circumstances and desires, the possibility of his return is reasonable to some outside doctors.
“When you first hear that and you don’t look at every part of it and dive into details, from afar you’re thinking, ‘That’s very fast and too soon,’ ” University of Colorado School of Medicine professor Eric McCarty said. “However, as we as sports medicine physicians look into it and see what has occurred and everything he has available to himself, we start thinking, ‘All right ... it’s in the realm of possibility.’
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“As sports medicine surgeons and sports medicine physicians, we are always pushing the envelope on trying to get our athletes back out on the playing field.”
How much to push those boundaries, though, is a fraught question. In Chhabra’s opinion, Rodgers is crossing the line between aggressive and reckless.
“The return back to play at this time is really just a high risk of re-rupture,” Chhabra said. “There’s been a rash of Achilles’ injuries this year in the NFL, and nobody else is talking about getting back sooner. From a physician’s standpoint, I think it’s aggressive. I think the risk is way too high because the second tear is career-ending, most likely. The literature doesn’t support it.”
“The fear we have as physicians is if he does come back and gets away with it, then everybody — high school kids, college kids — are going to want to come back in three months,” Chhabra added. “And then we’re going to see a rash of retears, which is going to be a very difficult thing to justify.”
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When an athlete can and should return cannot be distilled to a one-size-fits-all timetable, and an athlete’s position, age, contractual status, personal goals and level of care could all contribute to a more cautious or more aggressive schedule.
“It’s very easy for people to armchair quarterback. [This timeline is] certainly not common,” said Rush University sports medicine specialist Brian Cole, who is a team physician for the Chicago Bulls and Chicago White Sox. “The numbers people float are six to nine months. Does that mean we’ve been excessively conservative all along? Yeah, it’s possible. There’s an enormous risk aversion to the timeline of return to sport.”
At the Jets’ practice facility Thursday, Rodgers told reporters he would return only if the Jets’ playoff chances — which have dwindled to nearly zero — remain alive. But he didn’t rule out trying to play next weekend, either. He said he understood the risk of retearing his Achilles’ and that he would accept another, slower rehabilitation over the offseason if it happens.
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The problem with that logic, Chhabra said, is a second Achilles’ tear could be career-threatening.
“The results after a second time aren’t as good,” Chhabra said. “Everybody has a choice. Everything we do is a risk-reward ratio. Hopefully, we base things on science and want to do what’s in the best interest of the patient. I understand he makes a lot of money and is in the NFL and has a right to make his own decision. But is his physician who clears him to play liable? Are the Jets going to be responsible for his long-term care if he is limping in three years because he had a second Achilles’ [tear]? Those are the questions we ask in the medical-legal world nowadays.”
As long as Rodgers knows the risks, Cole said, he would have no objection to him playing. Even if Rodgers were to wait a year, there would be risk of a retear, albeit much smaller than if he played this week. If an athlete, his doctors and his organization all agree the level of risk is acceptable, then an outside opinion would be irrelevant, in Cole’s view.
“It is a calculated decision,” Cole said. “At the center of it is the athlete and his or her willingness to accept risk. I don’t worry this is a bad idea. There’s a lot of really smart people. Everyone understands what’s at stake here. There’s never zero risk. Football, every collision is like a motor vehicle accident. It’s a calculated, consensual decision that involves a lot of parties.”
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Rodgers has several factors working to his advantage, starting with the medical resources at his disposal. His surgeon, Neal ElAttrache, is the leading orthopedic surgeon among elite athletes. On Rodgers’s Achilles’ repair, ElAttrache reportedly used a device called a “speed bridge.” Along with repairing the tendon, doctors used stitches to anchor Rodgers’s tendon to his heel bone. The procedure provides additional support and protection, enabling movement in the foot and ankle more quickly after surgery.
“It’s fairly new, but it’s not like this is the groundbreaking, first time it has been used,” McCarty said. “It’s just the most highly publicized. It’s a good technique.”
“There’s been a lot of emphasis on [the speed bridge], and I don’t know if that is or is not the determining factor here,” Cole said. “It’s one surgical technique that’s used. It makes a lot of sense biomechanically and physiologically in an environment where we feel comfortable potentially pushing the envelope. But you still have to be very mindful of the detrimental effects of going too fast. It doesn’t give us a free pass to ignore biology.”
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Since the speed bridge was used, Chhabra said, it is probable that Rodgers suffered an Achilles’ tear in which the tendon came off the bone. Tendon-to-bone healing takes a minimum of 4½ months, Chhabra said, regardless of how the tendon is surgically repaired.
Rodgers’s position, some experts said, would help him. A quarterback still faces risks, but the positional demands on an Achilles’ tendon would allow him to return faster than a player whose role requires constant sharp cuts or explosive movement.
With 11 weeks having passed since his injury, McCarty said, Rodgers’s tendon would have healed by now. The tissue around the tendon, though, is still vulnerable. Even if Rodgers can move well in practice conditions, a sudden movement could result in additional risk of a retear. “It’s typically the unexpected forces you have to be careful with,” McCarty said.
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The final phase of Achilles’ tendon recovery, Cole said, is regaining skills, conditioning and endurance lost while rehabbing. For an experienced quarterback, that phase could be shortened significantly.
“Some athletes can go back at 80 percent and be better than others at 100 percent,” Cole said. “It’s not always about the injury and the structure that’s been repaired. It’s also about the nature of the athlete, the system they reside in and the demands of their sport and what they actually have to do in their sport.”
Running back Cam Akers is believed to have recovered from a torn Achilles’ faster than any professional football player. Akers tore the tendon in his right leg in the summer of 2021 and returned to the Los Angeles Rams less than six months later for the end of the regular season and the playoffs in January 2022, eventually starting in the Rams’ Super Bowl victory over the Bengals.
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McCarty applauded Rodgers’s competitiveness and willingness to push limits. He would not recommend an average person follow Rodgers’s timeline; most non-athletes who suffer an Achilles’ tear probably don’t need surgery at all, he said. But he believes Rodgers’s attempt will be studied and could help other professional athletes.
“Anytime we have these situations, we have to look at it and see if we could learn from it,” McCarthy said. “... We always learn from how we treat people, and we should get better at how we’re doing things. There is definitely going to be something to be learned from this that is going to help everybody. If we didn’t try these things, you would never know.”
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