While the torn Achilles tendon Ottawa Senators defenseman Erik Karlsson suffered last night has most likely ended his 2012 campaign, the combination of surgical repair, adequate recovery time, and intensive rehabilitation in the coming months should allow him to return to form in time for the start of the 2013-2014 NHL season.
The injury took place during a collision with Pittsburgh left wing Matt Cooke along the boards in the second period of Wednesday night's 4-2 loss to the Penguins, when Cooke’s skate struck the back of Karlsson’s lower left leg. The blade cut Karlsson’s Achilles tendon, a large, ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus), leaving the Senators defenseman in severe pain and unable to skate off the ice on his own.
Sometimes called the heel cord, the Achilles is largest tendon in the human body. When the calf muscles contract, the tendon is tightened, pulling the heel. This allows the foot to point and an individual to stand on tiptoe. It is vital to such activities as walking, running, and jumping. A complete tear through the tendon is called an Achilles tendon rupture, although luckily for Karlsson, the Sens say the tendon was 70 percent sliced, not fully sliced.
Treatment can be conservative (casting, rest, and rehabilitation) or surgical. Some studies show the long-term outcome is similar to surgery with regard to strength and function. However, compared with conservative management, surgery has a lower incidence of re-rupture than nonsurgical treatment and allows return to pre-injury activities sooner and at a higher level of functioning with less shrinkage of muscle, making it the option of choice for competitive athletes.
Surgical repair of a ruptured Achilles tendon requires physically suturing the ends of the tendon back together. Typically, as the rupture site heals, a small lump remains from the scarring, but this does not impact healing or resumption of physical activity. Full weight bearing commonly begins at about four-six weeks following surgery with a heel support, with the athlete often back on the ice for light skating at eight weeks. A return to full form typically requires six months of rehabilitation after surgery, which itself cannot take place until swelling resolves.
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There is precedent for attempting a return to action even earlier than the standard six months following surgery, as New Jersey Devils center Travis Zajac tried just four months following a ruptured Achilles tendon suffered prior to the 2011-12 NHL season. However, Zajac was shut down just eight games after returning to ice, taking an additional two months off before returning to action at full strength for the end of the regular season and playoffs. Zajac himself admitted in retrospect that four months of rehabilitation was not enough and that he could have used more time for further strength and conditioning.
One item that differs between Karlsson’s injury and most cases of Achilles tendon rupture is that a torn Achilles most commonly occurs about two inches above the heel bone when an individual makes a forceful push-off with the foot while the knee is straightened.
In Karlsson’s case, of course, the tendon was lacertated by Cooke’s skate blade, and it is unclear where along the Achilles the rupture took place. If higher up along the Achilles, near the calf muscles, surgery may require repair of structures in addition to the tendon itself, which could complicate the recovery process.
That said, regardless of the location of the injury, once fully healed Karlsson’s Achilles tendon should be strong enough not to significantly impact his skating speed or lower leg strength. This is one piece of good news for the Senators’ star defenseman, who with a successful surgery and rehab program should be able to take the ice at the start of the next season.