Ligament and Tendon Injuries – ACL and Achilles Ruptures in Elite Athletes

Tendon and ligament injuries are becoming more common in professional sports. ACL tears and ruptured tendon injuries like Achilles damage have forced top athletes in football, basketball, and track to miss entire seasons. These types of injuries can cut careers short and raise the risk of long-term joint issues.

Tendons and ligaments are key parts of how the body moves. When they tear, recovery takes months. A full comeback depends on good treatment, rehab, and sometimes surgery. Knowing how these injuries happen and how to manage them can improve long-term results.

Injury Trends in Elite Athletes

High Volume of Injuries

ACL and Achilles ruptures are on the rise across elite sports. Today’s athletes compete in longer seasons, with less recovery time between games, training sessions, and competitions. This constant load puts more pressure on soft tissues, especially tendons and ligaments, raising the risk of traumatic rupture.

Overtraining, combined with fatigue and repetitive movement, can weaken these structures over time—making them more likely to tear during high-speed or high-impact actions.

Notable Cases from Professional Sports

Several high-profile athletes have suffered recent injuries:

• Sam Kerr missed the 2024 Olympic qualifiers after an ACL tear.
• Cameron Brink was ruled out of her rookie WNBA season due to an ACL rupture.
• Skye Blakely both experienced Achilles tendon ruptures, cutting their seasons short just ahead of major international events.
• Lucas Hernandez missed the 2024 European Championships after tearing his left ACL.
• Asia D’Amato re-tore her left ACL during the Women’s All-Around Final, ending her Olympic bid.
• T.J. Hockenson tore his ACL and MCL in Week 17 of the 2023 NFL season.
• Daniel Jones suffered a torn ACL late in the 2023 season after returning from a neck injury.
• Kendrick Bourne tore his ACL in Week 8 of the 2023 NFL season.
• Mike Williams tore his left ACL in Week 3 of the 2023 season while playing for the Chargers.
• Nick Chubb sustained a major knee injury involving his ACL and MCL, requiring two surgeries.
• Elaine Thompson‑Herah tore her Achilles tendon during a race earlier this summer.
• Domenico Berardi ruptured his right Achilles tendon during a league match against Hellas Verona.
• Kayla DiCello ruptured her Achilles tendon during her vault routine at the Olympic trials.

These cases highlight just how sudden and serious these injuries can be. Even the best-conditioned athletes can be affected without warning.

Ligament and Tendon Injuries: ACL and Achilles Ruptures

What Ligaments and Tendons Do

Ligaments and tendons are tough, cord-like tissues that support movement and stability:

• Ligaments connect bones and help stabilize joints.
• Tendons connect muscles to bones and allow movement.

The anterior cruciate ligament (ACL) sits deep inside the knee joint. It helps control forward movement of the shin bone and provides stability during quick stops, pivots, and landings.

The Achilles tendon links the calf muscles to the heel bone. It’s the largest tendon in the body and helps generate power when muscles contract during running or jumping. It absorbs and releases huge amounts of force with each step.

Why They Get Strained

These tissues take on repeated stress, especially in high-performance sports. Movements like sprinting, jumping, cutting, and changing direction quickly place significant strain on the ACL and Achilles tendon.

Sports such as basketball, soccer, AFL, rugby, netball, and gymnastics place heavy loads on the knees and ankles. Track athletes also place intense stress on the Achilles tendon during explosive starts, landings, and sprint cycles.

Overuse, fatigue, poor technique, and reduced recovery time all increase injury risk. As athletes age or return from previous injuries, tendons and ligaments may also become less resilient due to gradual wear over time.

Most tendon injuries result from overuse or sudden force, with recovery often depending on early diagnosis and proper load management.

Injuries caused by forced flexion of a joint, especially during contact sports or falls, may require longer rehab times or surgical intervention depending on severity.

Some of these tissues are made up of tough fibers that resist damage, but when pushed beyond their limits—whether by impact, twisting, or body weight overload—they can tear or rupture.

Many of these injuries can happen suddenly, especially in sports involving fast direction changes, jumping, or awkward landings.

Common Injuries

The most common tendon problems in elite sport involve the Achilles tendon. One typical case is an Achilles tendon rupture, which usually happens during a sudden burst—like taking off to sprint or jumping. The tendon tears completely, often with a popping sound or the sensation of being kicked in the back of the leg. Walking becomes difficult almost immediately.

The most common ligament injury is an ACL tear. It often happens during non-contact movements such as pivoting, changing direction, or landing awkwardly. Athletes often feel or hear a pop, followed by swelling, pain, and knee instability.

Other soft tissue issues include:

• Commonly called tendinitis, this refers to short-term inflammation of a tendon, often caused by overuse or repetitive stress.
• Tendinosis – chronic wear-and-tear that leads to tendon degeneration.

These conditions can lead to stiffness, swelling, and finger pain in some cases, especially when they affect tendons in the hands or wrists. Left untreated, they may progress and cause ongoing discomfort or limit movement.

Treatment Options

A) Non-Surgical Treatments

Some partial tendon ruptures or less severe injuries can heal without surgery, especially in people who are less active or do not place heavy demands on the injured joint or tendon. The focus is on structured rehab and gradually restoring normal function while supporting the body’s healing process.

Treatment may include:

• Activity Modification – limiting jumping, cutting, or pivoting movements during early recovery
• Bracing or Support – using a brace or supportive device to protect the injured area and help with stability
• Physical therapy – a guided program that targets strength, flexibility, joint control, and proper movement patterns
• Neuromuscular Training – exercises that sharpen balance, coordination, and joint awareness
• Anti-inflammatory Medications – used short-term to help with pain and swelling

In some cases—especially with partial ACL tears or persistent Achilles symptoms—athletes may also receive injections such as platelet-rich plasma (PRP) or cell therapy using autologous bone marrow aspirate concentrate. These treatments are meant to support tissue repair and may help reduce recovery time. However, they’re typically used alongside rehab and not as a replacement for it. Results can vary based on injury type, timing, and the individual.

While nonsurgical treatment has its appeal, recovery still demands discipline and a clear plan. Skipping steps or returning to full activity too soon can lead to setbacks or re-injury.

B) Surgical Treatments

Complete ruptures—especially in elite athletes—usually require surgical repair to restore stability and support high-level performance.

• ACL Reconstruction involves removing the torn ligament and replacing it with a graft. This graft often comes from the athlete’s own hamstring, patellar or quadricep tendon (autograft), or in some cases, from a donor (allograft).
• Achilles Repair involves stitching the torn tendon ends back together. For larger tears, a graft may be added to reinforce the repair and improve tendon strength.

Surgery can offer a better chance of long-term joint stability, especially for athletes returning to high-impact sports. Still, it carries risks such as stiffness, infection, nerve irritation, or graft failure. Full recovery can take several months and requires a well-structured rehab program to regain strength, range of motion, and function.

C) Newer and Regenerative Options

In recent years, some clinics have introduced regenerative treatments to help with flexor tendon injuries and ligament healing. Two of the more common options include:

• Platelet-rich plasma (PRP) – an injection made from the athlete’s own blood, containing concentrated platelets and growth factors to help stimulate healing.
• Cell therapy using autologous bone marrow aspirate concentrate (BMAC) – uses cells taken from the patient’s own bone marrow to encourage tissue repair and improve blood flow

These therapies are generally added to rehab plans, not used as stand-alone treatments. While early research and clinical experience show some promise—especially for partial injuries or long-standing tendon issues—results can vary and are still being studied. Some treatments may be considered before opting for flexor tendon surgery in chronic or hard-to-heal cases. They may also support healing along with surgery, where inflammation or buildup of scar tissue can limit mobility.

Pros and Cons – Surgical vs Non-Surgical Procedure

Non‑Surgical Management

Not every tendon or ligament injury requires surgery. Partial tears, injuries in lower-demand individuals, and cases with good joint alignment can often be managed without an operation.

Initial treatment usually includes rest, ice, compression, and elevation (RICE) to control pain and swelling. This is followed by a structured rehabilitation program focused on restoring strength, flexibility, joint control, and neuromuscular coordination. Bracing may also help support the joint during recovery.

Pros of non-surgical treatment:

• Avoids surgical risks such as infection, bleeding, and scarring
• No need for general anaesthesia
• Shorter initial recovery period
• May provide similar long-term outcomes to surgery for some Achilles tendon ruptures, particularly in less active individuals

Cons:

• Higher risk of re-injury, especially in elite or high-demand athletes
• Persistent joint instability may remain in complete ACL tears
• In some cases, return to full sport may take longer
• Outcomes depend heavily on injury severity, rehab quality, and patient compliance

Some athletes—especially with partial tears—can return to their sport without surgery. The decision should be based on the type and severity of the tear, the athlete’s goals, and their willingness to commit to a strict rehab plan.

In cases involving an injured tendon, targeted rehab and close monitoring can make a significant difference in long-term function and pain control.

Surgical Treatment

Complete ACL or Achilles tendon ruptures often need surgery, particularly for athletes who depend on strong knee or ankle function for cutting, sprinting, and jumping.

• ACL reconstruction involves removing the damaged ligament and replacing it with a graft, commonly from the hamstring, hamstring, patellar or quadricep tendon (autograft), or occasionally a donor tendon (allograft).
• Achilles tendon repair involves stitching the torn tendon ends together. In more extensive tears, a graft or tendon transfer may be needed to bridge the gap or reinforce the repair.

Pros of surgical treatment:

• More predictable healing and recovery for complete tears
• Lower risk of long-term instability and meniscus tear damage in ACL cases
• Higher chance of returning to high-level sport in elite athletes
• Reduced re-rupture rates for Achilles tendon injuries in athletic populations

Cons:

• Carries some risks in a small number of cases like infection, nerve injury, stiffness, blood clots, or graft failure
• Longer recovery timeline with structured, progressive rehabilitation
• Some techniques—especially in ACL reconstruction surgery—may be associated with a long-term risk of knee osteoarthritis

Surgery can be preferred for highly active individuals, but the choice must fit the injury type, individual goals, tissue quality, and timing.

Regenerative Treatments with Orthobiologics

Some doctors now use regenerative therapies to support tendon or ligament healing, sometimes in combination with rehabilitation or after surgery. These treatments rely on the body’s own biological materials to promote tissue repair and improve recovery outcomes.

These include:

• Platelet-rich plasma (PRP) – a concentrated sample of the patient’s own blood is injected into the affected area to release healing factors
• Cell therapy using autologous bone marrow aspirate concentrate (BMAC) – bone marrow cells are taken from the patient and injected at the injury site to promote tissue regeneration

These treatments may help improve tendon or ligament quality, reduce pain, and support healing in partial or chronic injuries. They are typically used alongside structured rehabilitation programs and may also complement surgical repair in certain cases.

Pros of Regenerative Treatments

• Uses the patient’s own biological materials, reducing the risk of adverse reaction
• Minimally invasive with little to no downtime
• Can support natural healing and tissue regeneration
• May help reduce inflammation and pain in chronic or hard-to-heal injuries
• Can be used alongside rehabilitation or after surgery to enhance recovery
• May shorten overall recovery time compared to traditional approaches in select cases

Cons of Regenerative Treatments

• Outcomes can vary depending on injury type, severity, and timing
• Some injuries may still require surgical repair for full stability
• Clinical research is ongoing to determine long-term effectiveness and best applications

At Meier Orthopedic Sports Medicine, regenerative and orthobiologic treatments are an important part of our approach to tendon and ligament care. Our team has extensive experience using PRP and BMAC to help patients recover function and strength through advanced, biologically driven healing. These therapies reflect our commitment to integrating the most current, evidence-based innovations in orthopedic medicine to support optimal recovery and long-term joint health.

ACL Treatment Options: Traditional Reconstruction vs BEAR® Repair

Traditional ACL Reconstruction

For decades, reconstruction has been the standard treatment for complete ACL tears. The torn ligament is removed and replaced with a tissue graft—often from the athlete’s hamstring, patellar or quadricep tendon.

As helpful as ACL reconstruction can be to return some athletes to sports, only about 70% of patients return to their previous level of performance. Ligament reconstruction with a tendon graft may not fully restore the natural biomechanical stability of the knee, and some studies suggest there may be a long-term association with knee osteoarthritis, particularly in younger athletes.

BEAR® (Bridge-Enhanced ACL Repair)

ACL Repair & Regeneration with BEAR® Technology is a newer option that aims to preserve the athlete’s own ACL tissue. In this procedure, the native ACL tissue is retained, stitched back together and then covered with a collagen-based scaffold, soaked with the patient’s blood to protect the repair and stimulate healing and regeneration of the natural ACL tissue. 

Early studies suggest BEAR® may offer better joint preservation and a lower risk of osteoarthritis, since the native tissue with its innervation is preserved. Many patients find that their knee feels and moves more naturally following repair with the BEAR® approach than after a reconstruction. Not all patients with ACL tears are candidates, however. A repair may not be possible if the ACL tissue is damaged too severely or the tissue has deteriorated due to being neglected for an extended period. While the BEAR® procedure can be performed on several different ACL tear types, there must be sufficient remaining tissue to support a repair.

Pros and Cons of BEAR® (Bridge‑Enhanced ACL Repair)

Pros:

• Preserves the athlete’s own ACL tissue, maintaining natural anatomy and nerve supply
• Promotes biological healing through the use of the patient’s own blood and a collagen scaffold
• May reduce the long‑term risk of knee osteoarthritis compared to traditional reconstruction
• Helps restore more natural knee movement and stability
• Minimally invasive approach with smaller incisions and less tissue disruption
• Shorter early recovery period and faster return of strength in some patients
• Avoids graft harvest, reducing donor‑site pain or weakness
• Reflects the latest advancement in regenerative orthopedic surgery, emphasizing tissue preservation and healing

Cons:

• Not suitable for all ACL tears; adequate remaining tissue is required for repair
• Long‑term outcomes are still being studied as the procedure is relatively new
• As with any surgery, there is still a small risk of stiffness, infection, or incomplete healing

At Meier Orthopedic Sports Medicine, BEAR® technology represents a major advancement in ACL care and aligns closely with our philosophy of preserving natural tissue whenever possible. Our team is among the early adopters and advocates of this regenerative approach, using it to help athletes and active individuals recover knee function with greater confidence and long‑term joint health.

Thoughts on Ligament and Tendon Injuries

Ligament and tendon injuries, such as ACL and Achilles ruptures, are becoming more common in elite and recreational athletes. These injuries can severely affect performance, increase the risk of joint problems like osteoarthritis, and often require long recovery periods. Treatment options vary depending on the severity and may include non-surgical rehabilitation, surgery, or regenerative therapies like PRP and BMAC.

Non-surgical care works well for partial tears or lower-demand individuals, while complete ruptures in active athletes often require surgical intervention. Traditional ACL reconstruction remains a popular conventional treatment, but newer techniques like ACL Repair & Regeneration with BEAR® Technology are changing the landscape by preserving native tissue, resulting in greater patient satisfaction and potentially lowering arthritis risk. Regenerative medicine is also becoming a valuable tool to support healing and recovery when used alongside rehabilitation or surgery.

At Meier Orthopedic Sports Medicine, we specialize in advanced care for ligament and tendon injuries, offering the most current treatments—including the BEAR® ACL surgery for eligible patients. Our years of medical experience with cutting-edge therapies provide each patient with a high level of care, whether they’re elite athletes or active individuals looking to return to peak performance.

If you’re dealing with a knee or tendon injury and want expert guidance on your best treatment options, contact us to book an appointment. We’re here to help you recover stronger and faster with the latest in orthopedic care.