Which profile carries the greatest risk for an Achilles tendon rupture?

• A. A 38-year-old female who runs with a track club three nights a week
• B. A 45-year-old male who plays competitive tennis once a week
• C. A 32-year-old female who plays in a softball game every other weekend
• D. A 23-year-old male who plays in a pick-up basketball game once a month

Answer: (B)

Rupture risk increases with age, male sex, and the demand of explosive loading on the Achilles tendon, especially when the tendon may already have degenerative changes from years of use. This mix is most present in the middle-aged man playing competitive tennis, where rapid accelerations, abrupt stops, and lateral movements place high strain on the tendon. As men in their 40s and beyond continue to push for quick bursts on the court, the tendon’s ability to absorb energy can diminish, making rupture more likely than in the other profiles. The other scenarios involve either female sex, lower frequency of high-load activity, or less explosive demands, which generally carry a lower risk in comparison.