In the midst of the Buffalo Bills’ 28-21 victory over the Kansas City Chiefs in Week 9, the Bills lost versatile defensive lineman Michael Hoecht to a right Achilles tear.
A pyrrhic victory of sorts.
The injury occurred with 14:25 left in the fourth quarter when Hoecht ran a routine play, taking a false step and pushing off the right leg as his body weight was shifted forward, overstressing the Achilles tendon and causing it to rupture. He initially appeared to react as though he had his foot stepped on.
Despite the injury, Hoecht required assistance to get off the field but waved off the cart, instead sitting on the sidelines to support his teammates through the final frame. He was quickly ruled out with an Achilles designation, which is never a good sign.
Following the game, head coach Sean McDermott confirmed that Hoecht suffered an Achilles tendon tear and that he would be done for the season.
Read below for a detailed analysis of Michael Hoecht’s injury, risk factors, mechanism of injury, and future outlook.
Achilles Anatomy
The Achilles tendon is a band of connective tissue that connects the gastrocnemius to the calcaneus, allowing the foot to plantarflex (point down). This is essential during walking, jumping, running, and sprinting.
A rupture of the Achilles tendon occurs when an eccentric load is applied to the tendon, overloading the tendon and causing it to tear. This commonly occurs when a player is trying to push forward but gets driven back, such as blocking on the offensive line, cutting hard and pushing through the foot, as one would see in a running back or defensive end, or landing from jumping in the case of a defensive back.
These movements could lead to forceful dorsiflexion or the foot moving upward. This could also occur if the knee is extended and excess force is placed through the front of the foot, overstressing the Achilles tendon.
In Hoecht’s case, he took a false step, got his weight too far forward over his foot, drove off the right leg, and the tendon snapped.
Risk Factors for Achilles injury
There are a variety of risks for an Achilles tear, including the mechanical overload mentioned above, hypertension, obesity, and corticosteroid use, such as if he had pain in an affected joint and received an injection. These, over time, can weaken the tendon structures if given too often.
Otherwise, these injuries are sudden and typically come without warning, which makes this injury all the more devastating. There is usually a loud pop and immediate pain as if the person was stabbed or shot. Weakness and the inability to flex the foot down are common symptoms, and swelling and a possible gap in the tendon when palpating the area.
He did not have much of an injury history to begin with, which makes this injury all the more frustrating.
PED Suspension
An elephant in the room that needs to be addressed is the fact that Hoecht was coming off his six-game suspension due to a failed drug test early in the offseason. The Bills still signed him, knowing that the suspension was coming, as he was a free agent target. What triggered his failed drug test was testosterone given to him by a trainer he was working with.
There is a correlation between the use of testosterone and tendon injuries throughout the literature. This particular study highlighted Achilles tendon tears with the use of testosterone replacement therapy over two years in a wide age group of people.
The adjusted odds ratio for a person to suffer an Achilles tendon injury with resulting surgery was 1.24, with 9 percent of the cohort dealing with the injury. This is compared to the control group of 1.54 with 6.4 percent of the cohort suffering the injury. Keep in mind, the closer the odds to one, the higher the likelihood of the event happening.
The reason this happens is due to the excessive testosterone weakens collagen structure and elasticity. This makes the Achilles tendon and other major tendon attachment sites, such as the rotator cuff, more susceptible to injury.
I bring this up because his suspension for a failed drug test is public knowledge. It is easy to speculate that because of the test this caused him to be injured. We know there was too much testosterone in his system, but we don’t know how long or how much he was exposed to the increase in testosterone.
I am not stating that because of his positive test that he tore his Achilles tendon. There may be a correlation, but not causation. He could have injured his Achilles or rotator cuff, or any other major tendon during OTAs, training camp, or working out on his own; it doesn’t matter when it happened. It’s just unfortunate that it did.
Yes, there is a link within the literature that must be acknowledged given his recent history, but I am not stating this is what caused Hoecht’s injury.
That would be unfair to his character and nearly impossible to prove.
Diagnosis
Typically, Achilles tendon tears are easy to diagnose with the Thompson test. This is when the person is placed into a prone position, and the lower leg hanging off the table. The calf muscle is squeezed, and a positive test is when the foot does not plantarflex when the muscle is contracted due to the squeeze.
A more accurate test that was likely performed back in the locker room is the Matles test. The person lies on their stomach and bends their knee to 90 degrees. If the foot does not move or moves into dorsiflexion, then that is a positive sign that it is torn. The foot would normally slightly point downward in a negative test, indicating a tightening of the calf muscle that connects at the knee.
Surgery and Rehab
Surgery and rehabilitation take roughly six to nine months to return to normal activities and athletics for normal populations. Details of the various types of surgical repair can be viewed here.
Return to Play
The concern to re-tear in the NFL is closer to 15 percent, but this number may be more accurate as there are far more eyes on a smaller group of individuals than the general population that relies on outside data for studies. Normally, the re-tear rate is one-to-two percent in the general population.
Return-to-play rates do vary, but levels as high as 78 percent across all positions have been reported within the NFL, according to studies. The average amount of time takes 8.9 months. However, the return to play for a defensive lineman was at 328.2 days +/- 83.4 days, which equates to just shy of 11 months. Based on when Hoecht tore his Achilles on November 2, there is a possibility that he begins the season on PUP as he works his way back into shape.
Due to more aggressive rehab, there have been advances that have shaved the return to play in the NFL down to six to eight months. Improvement in performance following the injury has been observed, suggesting that this isn’t as much of a career-ender as it was a decade or two before.
Looking at the defensive line specifically, return to play is reported at 80 percent. However, there is a decline in games played the following season (12.2 +/- 4.0 vs 13.3 +/- 2.5 games) and a shorter career length (2.4 +/- 1.6 vs 3.3 +/- 2.0 years) as compared to controls. Unfortunately, the highest number of Achilles tendon repair surgeries occurred in defensive linemen.
There are research articles available that show the decline in performance following Achilles repair, but they do not appear to be publicly available. One study does state there is a 22 percent net decrease in power among all positions. How this translates out to statistical performance isn’t clear. We typically see tendon injuries like this allow a player to return to play the following season, but with decreased performance. However, this decline is decreased for the following season, and players can return to their prior level of performance two years removed from the injury.
This would put Hoecht in the final year of his three-year deal. By then, he will be 30 years old. We know that defensive ends age better than other positions but coming off a major injury, who knows what things will look like considering 2026 may not be a big production year.
Comparable Players
Former Baltimore Ravens linebacker Terrell Suggs famously returned in five months and six days, though he was only a partial tear. Others have returned and were productive, as noted in the linked article, including former Bill Takeo Spikes.
On the other hand, former Bill Shawne Merriman also suffered a partially torn Achilles, and returned, but retired within a year of return. Eagles guard Brandon Brooks suffered a torn Achilles tendon in 2018, returned in eight months for the 2019 season to play all 16 games before tearing the other side in 2020.
We have seen several instances of Bills players suffering an Achilles tear, including OL Ike Boettger, CB Tre’Davious White, DE Bryan Cox Jr, and DT DeWayne Carter. Boettger is currently not in football, Cox is in the CFL, White is no longer the player he once was, and Carter is still rehabbing from his Achilles tear in late August. The Bills medical staff knows how to rehab this injury, but it has lasting effects.
Final Thoughts
After serving a six-game suspension and coming in to play two games incredibly well, Hoecht’s season ended as quickly as it started. There is no chance for him to return for the postseason, and 2026 is very much affected by this injury due to the timing with the possibility of starting on PUP even with an excellent rehab.
Even if this is a partial tear for Hoecht, he still needs to have the area repaired and go through the necessary rehab to be ready to play next season.
I feel for Michael Hoecht. He got the opportunity to cash in on stellar play in Los Angeles, signed a new contract, got suspended, and then suffered a season-ending injury.
I would like to wish Michael Hoecht the best of luck in his recovery and return to the football field in 2026.
Top Photo Credit: NBC Sports
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