By: Dr. Nirav Pandya
Assistant Professor, Orthopedic Surgery, UCSF
I am an orthopedic surgeon during the day, but a Warriors fan 24/7. As we all suffered through a taxing 2020, the possibility of finally seeing Steph, Klay, and Draymond back together on the court was tantalizing. But then the unthinkable happened: reports surfaced that Klay had suffered a lower leg injury that was deemed serious. A momentary sigh of relief came when many of us learned it was not on the same leg that he had undergone anterior cruciate ligament (ACL) surgery. Yet, that glimmer of hope was crushed when it was confirmed he had suffered an Achilles tendon rupture. Unfortunately, Dub Nation is all too familiar with players going down with these Achilles tears: whether it be player with a history of a tear (DeMarcus Cousins), or a player who tears his Achilles in front of our eyes (Kevin Durant).
In order to understand the impact this injury will have on both Klay (and the Warriors), we all need to step back and review some basics about Achilles tendon injuries. The Achilles tendon is a strong fibrous cord that connects the calf muscles to your heel bone; helping you to push off while walking, running, or jumping. As a result, a complete tear in an athlete can be devastating as it limits their explosive ability while playing sports. The vast majority of tears occur in males between the ages of 35-45 who play recreational sports (“weekend warriors”). In professional athletes who are younger , the Achilles can tear due to bad luck, increased workload over the preceding games, and/or compensation from another injury. Although we can never be certain (and to be clear I have not examined Klay nor taken care of him), many of us in the medical community believe that Klay tore his Achilles due to possibly compensating in the way he was moving as he recovered from his ACL surgery.
For elite athletes, surgery is the most predictable treatment option for a complete Achilles tendon tear. During the surgery, we literally sew the Achilles tendon back together. This allows the body to heal the ends together so that flexibility, strength, and explosiveness can return. Recovery typically takes 9 – 12 months. The natural question that many will ask is why should we be so concerned about an injury that sounds pretty straightforward to fix? Here is where the complicated part comes into play.
Unlike ACL surgery where a brand new piece of healthy tissue replaces the torn ACL, Achilles surgery is not a replacement but rather a repair. We are basically sewing together tissue that may have some degree of degeneration together in order for the body to “fuse” it. After the tissue heals, it needs to generate power so you can push off during running and jumping. An Achilles powers your athletic activity. In contrast, an ACL provides stability (it doesn’t actively help move your body).
So while all this information may take you back to your high school biology class, the information that we all want to know is when will Klay return, and how will it affect his performance. If we look first at ACL tears in NBA players, Kester et al. in the journal Knee Surgery, Sports Traumatology, Arthroscopy looked at 79 players who tore their ACL over a 20-year period. Nearly eighty-six percent of players returned to play, but their careers were shortened by nearly 2 years. In 2019, Lemme et al. in the American Journal of Sports Medicine analyzed 44 Achilles tendon ruptures that occurred in NBA players between 1970 – 2018. The mean age of the players was 28.3 years. Of these 44 players, 36.8% never returned or played less than 10 games their entire career. Of those who returned, it took 10.5 months on average to return with a decline in their Player Efficiency Rating (PER) of 2.9 points (for reference Klay’s career PER is 16.4). If you look at the list of notable NBA players that have torn their Achilles and have returned to play, the list includes Elton Brand, Kobe Bryant, Rudy Gay, Wesley Matthews, Chauncy Billups, and Dominique Wilkins.
For a ray of hope, Warriors fans can look to the example of Wilkins who returned from his Achilles injury at the age of 32 to make multiple All-Star teams. In addition, surgical techniques and rehabilitation have advanced. Klay is also not a vertical-based player who depends on exploding to the basket to anchor his game. And perhaps most importantly is his mental strength: the ability to brush all the negativity and hesitation aside, and just play basketball with confidence in his legs. We will see Klay back on the court soon, re-uniting the Splash Brothers at the Chase Center.