Abstract
Dear Editor:
We read with interest the recently published article titled “Performance and Return to Sport After Achilles Tendon Repair in National Football League Players” by Jack et al. 1 The authors report an Internet search of National Football League (NFL) players who sustained an Achilles tendon rupture between 1958 and 2016, reporting return-to-sport data compared to individual matched controls. They report a total 172 surgeries in 170 players, of which only a total of 98 surgeries in 95 players were ultimately included in their analysis due to limitations of available data, lack of follow-up, or determination of no NFL experience with the other 75 players. We have several concerns regarding the scientific validity of this, as well as other Internet-only research studies:
If the goal of research is to ultimately improve our understanding of the impact of various conditions/injuries and how it relates to patient care, then it is important that published data be as accurate and representative of the condition being discussed as possible. Considering this, we believe the data source used for this study to be inaccurate. We performed a manual Internet search of every NFL team and player and found 9 bilateral ruptures and over 115 total ruptures since 2010 (unpublished), which is very different from the 1 player with reported bilateral ruptures and the comparatively low total number of ruptures in the NFL for the timeframe reported in this study. This spot check highlights our larger concern regarding the depth and breadth of the current authors’ search over the other 50 years’ worth of player data that are reportedly represented.
We believe that reporting return-to-play and performance metrics on current players in the NFL combined with those dating back to 1958 to be a limitation of this study and inappropriate. The game of football, athletes, available treatment options, and rehabilitation for these injuries are very different today compared to 60 years ago, and to include all of these athletes together in a bundled analysis seems flawed. Furthermore, although understood as a limitation of Internet-only studies, given the fact the authors report no medical information regarding anatomic location of the rupture (insertional vs noninsertional) and no report on the type of surgical procedure, we feel it dangerous to attempt to draw reliable conclusions from these data.
To preserve the integrity of medical research as well as provide accurate conclusions and recommendations to the readership, we believe that a combined reporting of patient medical information as well as performance data is necessary for accurate return-to-sport data. This has been an ongoing concern of ours in other Internet-based studies (Lisfranc fractures, Jones fractures) whereby radiographs are not reported and thus the injuries are not stratified in any way.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
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