Will Kobe Bryant ever be the same?

The injury

Laker nation held their breath as this happened:

After the injury, many believed that Kobe would be able to come back from this devastating injury - but can we expect this to be true?  Kobe is as dedicated an athlete as they come but can he play at an elite level after this injury?

In athletes, the Achilles tendon is one of the most important tendons in the body.  It attaches to the calf muscle and is mainly responsible for a basketball player's ability to drive and jump.  It generates a lot of power and quickness can be determined by the strength of the Achilles.  The Achilles tendon itself is one of the strongest in the body but because of its responsibility and use, it is commonly injured.  A complete rupture of the tendon, as seen in Kobe Bryant and David Beckham, is often found in a 'watershed' area of the Achilles tendon.  The watershed area is located approximately 2-6 cm above its insertion into the heel bone and it is an area with low vascularity or blood supply which predisposes the tendon to injury and rupture.  Overuse of the tendon may also predispose an athlete to rupture of the tendon, but sudden movements or a stress that the Achilles tendon can not handle can cause the tendon to tear.

Can Kobe return from this injury? 

There are several studies that describe return to normal activity in athletes but not many that involve elite athletes like Kobe Bryant.  In a recent journal article in the American Journal of Sports Medicine, the authors reviewed injury reports of 18 players in the National Basketball Association (NBA) who had an Achilles rupture which was surgically repaired.  The average age of the players was 29.7 years old and the average playing experience of the players was 7.6 years.  Of these 18 players, 7 did not return to play another NBA game, 11 played one additional season, and 8 returned for 2 or more seasons.  Players who returned were generally less effective and the average player efficiency rating  (PER) was reduced by 4.57 in the first season and 4.38 in the second season.

Although this is a small sample size, these numbers do not bode well for Kobe Bryant.  He is now 34 years old and has 16 years of NBA experience, which are both above average in the study.  As the body ages, the tendons tend to lose elasticity.  Therefore tendons are more fragile and cannot handle as much stress.  With Kobe Bryant's injury, the tendon will likely heal with residual scar tissue and chances are that he will not have as much power in that leg as before his injury.  This will likely affect his ability to drive and jump.  Therefore it will affect his ability to create his own shots, ability to get to the line, and his jump shots.

Will Kobe Bryant's tendon be as strong as before his injury?  

With the already weakened state of Kobe's tendon, can we expect his tendon to repair and become better than before the injury?  Most studies say that after surgical repair there is some residual weakness to the Achilles tendon.  A recent study reviewed 63 patients with an average follow up of 10.8 years after a surgically repaired Achilles tendon to assess muscle strength and muscle activity 10 years after surgical repair.  Muscle activity in the injured leg was found to be increased compared to the uninjured leg, suggesting that other muscles were compensating for a weak calf muscle and Achilles tendon even 10 years after an Achilles rupture.

Therefore, although Kobe Bryant has access to world class rehabilitation facilities, Kobe's injury will likely rob him of some strength in his Achilles.  Other muscles in the lower leg will likely help him to compensate for this loss strength and he may still be able to play at an effective level.  However, Kobe's game is driven by his Achilles.  His ability to drive and shoot jump shots require his Achilles to be healthy and strong.

Kobe's future

I believe that Kobe Bryant will return to play in the NBA.  However, I believe he will be a very different player.  He will likely have some residual weakness in his Achilles, which will rob him of some of his quickness.  Kobe is a very smart player though, and he will learn to adapt to his body.  He'll still be able to read defenses and make smart decisions with the ball and he'll learn to make jump shots with his repaired Achilles.  And if he returns, can someone tell Mike D'Antoni not to play him 38 minutes/game?

Resources: 

Amin NH, Old AB, Tabb LP, et al.  Performance outcomes after repair of complete Achilles tendon ruptures in National Basketball Association players.  Am J Sports Med; June 3, 2013 (Epub ahead of print)
Horstmann T, Lukas C, Merk J, et al.  Deficits 10 years after Achilles tendon repair.  Int J Sports Med 2012; 33(6): 474-9