Pickleball-Associated Achilles Tendon Ruptures: Shifting Achilles Repair Demographics.

Background: Pickleball has emerged as the fastest-growing sport in the United States, with participation increasing nearly 1000% since 2019 and now surpassing 36 million players. Within the same period, tennis participation has risen by 33%. Pickleball's rapid rise, accelerated by the COVID-19 pandemic, has paralleled anecdotal reports of musculoskeletal injury, yet little is known regarding Achilles tendon rupture (ATR) risk in this population. Tennis, a sport with similar biomechanics, has long been studied in relation to ATR, but comparative data for pickleball is lacking. The purpose of this study is to compare ATR proportional frequency sustained during pickleball, tennis, and all other sports to identify patterns of risk and inform athlete counseling. Methods: A retrospective review was conducted from January 2018 through December 2022 to identify patients who underwent Achilles tendon repairs within a large, independent orthopaedic group (>100 surgeons). Procedures were identified through the Results: Pickleball ATRs occurred in significantly older patients (median 60 years) compared with tennis (45 years) and other sports (37 years) ( Conclusion: Pickleball-associated Achilles tendon ruptures represent a distinct demographic pattern, predominantly affecting adults >50 years of age, with a marked increase in cases following 2020, suggesting a correlation with the start of the COVID-19 pandemic. With the numbers available, no significant difference in postoperative complication rates was detected; however, the relatively small number of pickleball injuries limits statistical power and precludes definitive conclusions regarding comparative safety or injury patterns compared with tennis or other sports. Level of Evidence: Level III, retrospective cohort study.