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You can look The fracture of Kevin Durant's Achilles tendon in gif form, if you will. Everything is on the Internet – the Golden State Warriors scoring machine bounces the ball between his legs to try to pass Serge Ibaka of the Toronto Raptors, stands out from his right leg and pivots to his left, showing Ibaka his back .. and when Durant rests after the turn, something is wrong. He felt an explosion, like being hit on the back of the leg. During box off the court.
He would later report on Instagram that in reality his right Achilles tendon had broken, that he had been operated on to repair it and that he would no longer play basketball for a while.
So what happened here? Why would a part of the human body, especially one so perfectly prepared to do what it was doing, break up suddenly?
What you probably think of your calf muscle is actually two muscles that work together – the gastrocnemius and the soleus. These are attached to the back of the leg and when they contract, they pull the heel up – it is this action that allows plantar flexion of the foot: walk, run, jump and cut. The Achilles tendon is the thing that connects these muscles to this bone, a whitish, shiny collagenous ribbon, a quarter of an inch thick, located just under the skin. It is viscoelastic, which means that it can store and release energy, almost like an elastic band. "It's an explosive boost," says Drew Lansdown, an orthopedic surgeon at UC San Francisco Medical Center.
So, it's a strong tendon. "The Achilles tendon is really well designed to support loads that are several times greater than our body weight," says Jennifer Zellers, a postdoctoral researcher studying Achilles tendon rupture at the University of Washington in St. Louis. "If I tried to pull it with my hand, I probably would have slipped before I could stretch it out. With my strength in the upper body, I could not distort it. "
John Bavosi / ScienceSource
Still, sometimes it's going to pop. This usually happens without any noticeable symptoms beforehand, but that does not mean that nothing happens. "Number one is degeneration of the tendon, which we call clinically tendinosis," says J. Turner Vosseller, an orthopedic surgeon specializing in the feet and ankles of the Columbia University Medical Center. Tendinosis involves changes at the cellular level that end in a breakdown of the collagen matrix. This also happens with tennis elbow injuries and rotator cuff injuries. A study of healthy young people found that 16% of them had symptoms of tendinosis that an MRI could detect, which Vosseller calls "shit tendons".
So what? In an "eccentric contraction", the muscle contracts to control the foot, but also extends to allow dorsiflexion – pointing the toes upwards. (A "concentric contraction" points the foot in the other direction.) "One can have a tear with one or the other type of contraction, but the eccentric imposes the most tendon stress, "says Lansdown. Combine a tendon already in difficulty and a bit of bad luck to get a break.
Nobody really knows why some people catch them and others do not: sofa potatoes are probably less vulnerable and more active people are probably more likely. This occurred more often in young people, in their thirties, but as older people became more active, Achilles tendon rupture became common among those over 40 years old. And before Title IX brought equality to men's and women's sports, many more men were usually ruptured than women. Now the ratio is about three to one.
The question is what to do: for civilians and for elite athletes like Durant. Surgery was the usual approach, but over the past decade, non-surgical options have improved. "The goal of the initial treatment after the breakup is simply to bring the two ends of the tendon closer together so that they can heal and reshape," Zellers says. "We immobilize people's ankles in a position where both ends can meet."
The tendon is not so elastic, it turns out that after a break, it retracts like a vacuum cord. In fact, it will remain almost in place for days – or rather, if, after MRI examination, the broken ends are still about one centimeter away, says Zellers, this person is a good candidate for non-surgical treatment. Studies showing that the risk of recurrence is low enough with the nonsurgical option have increased its use over the last decade; now, almost half of people with Achilles tendon rupture never go under the scalpel.
Athletes at Durant, however, tend to have surgery. This is the most predictable way to reduce the time of return to play with as much force as possible. The incisions have become smaller, which, according to doctors, speeds up the healing time. And even the approach you'd think would be the most straightforward – making ends meet and suturing them together – has dissidents. "We have actually looked at the whole tendon in people with Achilles tendon rupture, and it's all often degenerative, not just in focus, in one area," Vosseller explains. He mentions an interesting study done in Denmark, where researchers have incorporated tantalum beads that an X-ray could identify at the ends of achilles tendons ruptured during repair. Although the tendon was sewn, the pearls still migrated separately. "Even though they had repaired, there was some kind of creep in the system. It's getting longer, "he says. So now, another surgical approach is to put the sutures closer to the top of the tendon and attach them to plastic screws driven into the heel bone.
Recovery after surgery takes a long time for anyone to regain their condition prior to this type of injury. The Vosseller team compared statistics of professional baseball, basketball and hockey players before Achilles tendon rupture, then a year and two years later with those of statistically and unscathed equal players. & # 39; find their previous skill for two years. And the news is not very good in the NBA: in a small study, barely 18 players over two decades, none of them has recovered its previous level of skill and nearly 40% did not return at all . "Even here, it depends on the position. Recovery is more difficult for guards, for example, who have to make more cuts and cuts, "says Marc Safran, orthopedic surgeon and head of sports medicine at Stanford.
But not everything is lost. His teammate DeMarcus Cousins has experienced a remarkable recovery after his own tear of Achilles in 2018, for example. "One of the best indicators of the quality of a person's performance after a breakup is its quality before," said Zellers. If that's true, it's hard to think of a better bet than Kevin Durant.
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