Achilles' tendon rupture dancing the ‘Jerusalema’ – A case series

Abstract

Introduction and importance The weekend warrior has long been prey to musculoskeletal injuries as a result of intermittent, high intensity activity. The Achilles tendon is known to be particularly vulnerable in this population cohort but during the COVID-19 lockdowns in Ireland and all over the world there has been a certain level of detraining and deconditioning among all age groups and populations. Throughout the worldwide restrictions, viral internet challenges and dances have encapsulated the spirit of a global community with the ‘Jerusalema’ dance being no exception. The rise of this particular viral sensation was at the detriment of the Achilles tendons of three middle aged gentlemen on who we base our case series. Presentation of cases Over the space of ten days three cases of Achilles tendon rupture repair presented to the emergency department in Midlands Regional Hospital Tullamore (MRHT) with the mechanism of tendon rupture being through the ‘Jerusalema’ dance. These patients were surgically managed in line with local institution practice and postoperative outcomes were good with no complications noted. Follow up is ongoing. Clinical discussion This retrospective case series is based on the impact of the ‘Jerusalema Dance’ on presentations of Achilles tendon rupture to the Emergency Department in a single regional hospital from January to March 2021. We used these cases in conjunction with a review of current literature to highlight the benefit of an integrated Achilles Tendon rehabilitation programme in this at-risk patient cohort. Conclusion This paper highlights the dangers inherent when well intentioned, but physically deconditioned individuals endeavour to perform a physical exercise which is deceptively demanding. Going forward, viral challenges such as the ‘Jerusalema’ may contribute to new and interesting mechanisms of injuries in our ‘weekend warrior’ cohort. In addition to this, given the global deconditioning seen due to the COVID 19 pandemic and subsequent lockdowns we may see a higher rate of Achilles tendon injuries in the near future across a multitude of patient cohorts. Level one evidence suggests that conservative treatment is just as effective as surgical treatments in the majority of patients with an Achilles tendon rupture, as long as a protocol of rehabilitation with early weightbearing is performed. Our accelerated rehabilitation programme in MRHT is in line with others however internal audit and new literature in the future may enable us to refine it further.

Increased incidence of acute achilles tendon ruptures in the peri-pandemic COVID era with parallels to the 2021–22 NFL season

“…This is especially true pertaining to AATR injuries, which are particularly prone to disuse, atrophy, and tendinosis [ 15 , 20 ]. Roopnarinesingh et al published a small case series of three patients who sustained AATRs over a ten-day period in 2021, all due to the ‘Jerusalema’ dance, and highlighted the importance of precautions when returning from COVID induced lack of physical activity to deceptively demanding physical activity [ 27 ]. An investigation by Baker et al demonstrated that NFL injuries spiked significantly in the first four weeks of the 2020–2021 regular season after the 2020 preseason was canceled due to the COVID pandemic [ 2 ].…”

Tension offloading improves cutaneous scar formation in Achilles tendon repair

“…Furthermore, tension offloading of the skin following Achilles repair may mitigate mechanopathologic stimulus for scar formation associated with early post-operative mobilization and daily physical therapy range-of-motion exercises. Given the sudden increase in Achilles tendon ruptures since the onset of the COVID pandemic, this case study provides data of this device’s potential therapeutic use to the increasing number of patients undergoing this procedure [ 14 , 15 ].…”