Game Utilization and Performance Following RTP From ACL Reconstruction Does not Influence a Subsequent Second ACL Injury in National Football League Players

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, and they can have a negative impact on players’ ability to return to play (RTP). There is a paucity of literature focused on RTP after ACL reconstruction (ACLR) in collision sports. Purpose: To characterize the impact that an ACL injury has on the ability to RTP and the post-ACLR performance level in American football players. Study Design: Systematic review; Level of evidence, 4. Methods: An electronic search was performed using the following databases: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Included studies were written in English; were published since the year 2000; examined only American football players; and reported on RTP, performance, and/or career length after primary ACLR. Results: The initial search yielded 442 unique studies. Of these, 427 were removed after screening, leaving 15 studies that met inclusion criteria. An additional 2 studies were identified in these studies’ references, yielding a total of 17. The rate of RTP after ACLR for football players was 67.2% (1249/1859), and the mean time to return was 11.6 months (range, 35.8-55.8 weeks). Although considerable heterogeneity existed in the study design and outcomes measured, in general, a majority of football players experienced greater declines from their preinjury performance level than controls over the same time period. Conclusion: An ACL injury negatively affected football players’ ability to RTP and their post-ACLR performance. The degree of effect varied by several factors, including playing position, preinjury performance level, and National Football League Draft round. These results may be used by physicians and football players to develop reasonable expectations for returning to play and performance after an ACL injury.

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Recurrent Anterior Cruciate Ligament Tears in the National Football League: A Case-Control Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119891413 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711989141 ◽

Cited By ~ 1

Author(s):

Casey R. Stuhlman ◽

Christopher J. Owens ◽

Eric M. Samuelson ◽

Ryan P. Vermillion ◽

Mark D. Shermansky ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

National Football League ◽

Cruciate Ligament ◽

Acl Injury ◽

American Football ◽

Matched Cohort ◽

Control Cohort ◽

History Of ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are common in American football players. The risk of subsequent ACL reinjury to either the ipsilateral or the contralateral knee in National Football League (NFL) draftees with a history of successful ACL reconstruction before entering the NFL remains unknown. Hypothesis: NFL athletes with a history of successful ACL reconstruction before being drafted will likely demonstrate increased risk of subsequent ACL injury when compared with a control cohort consisting of players of similar positions and draft class. Study Design: Cohort study; Level of evidence, 3. Methods: Detailed orthopaedic evaluations of NFL Combine participants from 2006 to 2012 were obtained to identify players entering the NFL draft with a history of successful ACL reconstruction. A control cohort was created in a 2:1 ratio, consisting of players matched by position and draft class. Results: Of the 2016 players invited to the NFL Combine during the study period, 100 met the inclusion criteria. A total of 26 subsequent ACL reinjuries (12 ipsilateral, 14 contralateral) occurred in 25 players (25%) while playing in the NFL, with injuries occurring at a mean of 22.1 months after the NFL draft. In comparison, 18 of the 200 (9%) carefully matched cohort players without history of prior ACL injury sustained a new ACL injury during this time period ( P < .001). Conclusion: NFL athletes with a history of successful ACL reconstruction before being drafted into the NFL have a significantly higher rate of subsequent ACL reinjury while playing in the NFL when compared with a carefully matched cohort of players without a history of prior ACL injury.

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Association of Prior Anterior Cruciate Ligament Tear With Decreased Career Longevity in Women’s National Basketball Association

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211009248 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110092

Author(s):

Joseph S. Tramer ◽

Lafi S. Khalil ◽

Toufic R. Jildeh ◽

Mohammad Sattar ◽

Alexander Ziedas ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Acl Injury ◽

National Basketball Association ◽

Healthy Controls ◽

Acl Tear ◽

History Of ◽

Anterior Cruciate ◽

And Performance

Background: The incidence of anterior cruciate ligament (ACL) injuries in women’s basketball exceeds that of men. There is a paucity of data regarding career performance in Women’s National Basketball Association (WNBA) athletes with a history of ACL reconstruction. Purpose: To determine whether WNBA athletes with a history of ACL injury prior to professional play have reduced career game utilization, defined as games played and started and minutes per game (MPG), as well as statistical performance, defined by player efficiency rating (PER). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 42 WNBA players from 1997 to 2018 who had a history of ACL reconstruction before entering professional leagues. Body mass index (BMI), age, and position were collected for each player. Career data and performance statistics were likewise collected for each player’s entire WNBA career. A control group of WNBA players with no history of ACL injury were matched by position, BMI, and age at the time of WNBA debut. Statistics compared game utilization and performance to assess the impact of ACL reconstruction. Results: Athletes who sustained an ACL tear before entering the league played in fewer games per season in their first 3 professional seasons compared with healthy controls (24.2 ± 8.4 vs 28.2 ± 6.1; P = .02). Among athletes with a history of ACL reconstruction, 11 (26.2%) played only a single WNBA season, while no control athletes played in just 1 season. Additionally, athletes who had a previous ACL tear started significantly fewer games per season (9.0 ± 9.4 vs 14.0 ± 9.0; P < .01) and played fewer MPG (15.5 ± 7.2 vs 20.7 ± 5.5; P < .01) during their WNBA career. Athletes with a history of ACL tear had significantly shorter WNBA careers (4.8 ± 4.1 vs 8.1 ± 3.3 seasons; P < .001). Total professional play duration (WNBA + overseas) was significantly reduced in players with an ACL tear compared with controls ( P < .05). PER was not significantly different between cohorts at any time point. Conclusion: WNBA athletes with a history of an ACL tear before professional play had decreased career game utilization and workload throughout their career despite having similar PER compared with healthy controls.

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High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103555 ◽

2021 ◽

pp. bjsports-2020-103555

Author(s):

Francesco Della Villa ◽

Martin Hägglund ◽

Stefano Della Villa ◽

Jan Ekstrand ◽

Markus Waldén

Keyword(s):

Acl Reconstruction ◽

Cox Regression ◽

Injury Rate ◽

Acl Injury ◽

High Rate ◽

Football Players ◽

Professional Football ◽

Cox Regression Analysis ◽

Career Length ◽

Increased Risk

BackgroundStudies on subsequent anterior cruciate ligament (ACL) ruptures and career length in male professional football players after ACL reconstruction (ACLR) are scarce.AimTo investigate the second ACL injury rate, potential predictors of second ACL injury and the career length after ACLR.Study designProspective cohort study.SettingMen’s professional football.Methods118 players with index ACL injury were tracked longitudinally for subsequent ACL injury and career length over 16.9 years. Multivariable Cox regression analysis with HR was carried out to study potential predictors for subsequent ACL injury.ResultsMedian follow-up was 4.3 (IQR 4.6) years after ACLR. The second ACL injury rate after return to training (RTT) was 17.8% (n=21), with 9.3% (n=11) to the ipsilateral and 8.5% (n=10) to the contralateral knee. Significant predictors for second ACL injury were a non-contact index ACL injury (HR 7.16, 95% CI 1.63 to 31.22) and an isolated index ACL injury (HR 2.73, 95% CI 1.06 to 7.07). In total, 11 of 26 players (42%) with a non-contact isolated index ACL injury suffered a second ACL injury. RTT time was not an independent predictor of second ACL injury, even though there was a tendency for a risk reduction with longer time to RTT. Median career length after ACLR was 4.1 (IQR 4.0) years and 60% of players were still playing at preinjury level 5 years after ACLR.ConclusionsAlmost one out of five top-level professional male football players sustained a second ACL injury following ACLR and return to football, with a considerably increased risk for players with a non-contact or isolated index injury.

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20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

The American Journal of Sports Medicine ◽

10.1177/0363546517741497 ◽

2017 ◽

Vol 46 (3) ◽

pp. 531-543 ◽

Cited By ~ 61

Author(s):

Lucy J. Salmon ◽

Emma Heath ◽

Hawar Akrawi ◽

Justin P. Roe ◽

James Linklater ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Degenerative Change ◽

Acl Injury ◽

Hamstring Tendon ◽

Activity Level ◽

Acl Graft ◽

Hamstring Tendon Autograft ◽

Graft Rupture ◽

Tendon Autograft

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

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Distal Biceps Ruptures in National Football League Players: Return to Play and Performance Analysis.

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.11.010 ◽

2020 ◽

Author(s):

Andrew McGinniss ◽

Luis A. Guinand ◽

Michael Vosbikian ◽

Irfan Ahmed

Keyword(s):

Performance Analysis ◽

National Football League ◽

Return To Play ◽

Distal Biceps ◽

And Performance

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An Empirical Investigation of Violence Against Women in the NFL

Journal of Sport and Social Issues ◽

10.1177/01937235211043645 ◽

2021 ◽

pp. 019372352110436

Author(s):

Krystyna Gotberg ◽

Jacquelyn D. Wiersma-Mosley

Keyword(s):

Substance Abuse ◽

Violence Against Women ◽

Empirical Investigation ◽

National Football League ◽

Driving Under The Influence ◽

Public Attention ◽

Violent Behaviors ◽

And Performance ◽

Performance Enhancing Drugs ◽

Violent Offenses

The purpose of this study was to examine violence against women (VAW) in the National Football League (NFL). Since Ray Rice assaulted his partner on video, VAW by NFL players has received more public attention. However, there is little empirical research that examines VAW in the NFL and player suspensions compared to other violations. Data come from a public list of 176 NFL players known to have violated NFL policies from 2010–2019. Four major types of violations were found: VAW included sexual assault, rape, and domestic violence; general violent behaviors included assault or battery; drug-related offenses included substance abuse, alcohol, driving under the influence (DUI's), illegal drugs, and performance-enhancing drugs (PEDs); and minor sports-related infractions included issues such as missing a team meeting. The average number of game suspensions was 4.08 for VAW offenses, 1.75 for general violent offenses, 4.05 for drug-related offenses and 1.88 for minor infractions. We found no differences in the number of game suspensions for drug-related offenses compared to VAW; general violent offenses had even fewer suspensions. These numbers are contradictory to the NFL's Personal Conduct Policy of a 6-game suspension without pay for VAW and general violence.

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A Cam Shaped Femur Might Be A Risk Factor for ACL Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00139 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0013

Author(s):

Thomas Rudolf Pfeiffer ◽

Jeremy M. Burnham ◽

Ajay C. Kanakamedala ◽

Jonathan Daniel Hughes ◽

James J. Irrgang ◽

...

Keyword(s):

Acl Reconstruction ◽

Injury Risk ◽

Roc Analysis ◽

Femoral Condyle ◽

Academic Medical Center ◽

Acl Injury ◽

Control Group ◽

Acl Injuries ◽

Increased Risk ◽

The Mean

Objectives: Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. While posterior femoral condyle condylar offset is an aspect of distal femoral bony morphology that has been reported to influence range of motion and other aspects of knee joint kinematics, it remains unclear whether this characteristic influences the risk of ACL injury. The purpose of the study was to examine the relationship between distal femoral morphology and risks of ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the cam ratio, would correlate with increased risk of primary ACL injuries, ACL reconstruction failures, and contralateral ACL injuries. Methods: Consecutive patients undergoing evaluation for knee complaints at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the cam ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal cam ratio cut-off for detecting increased risk for ACL injury. Results: One hundred and seventy-five patients met inclusion criteria. The mean cam ratios in the control, primary ACL injury, failed ACL reconstruction, and contralateral ACL injury groups were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher cam ratio compared to the control group (p<0.008). ROC analysis demonstrated a cam ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of83% and a specificity of 71%. Conclusion: The data from this study show that an increased posterior femoral condylar depth, or cam ratio, might be associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. The data from this study may help clinicians identify patients at greater risk of ACL injury and re-injury. Future prospective studies will be helpful in investigating the mechanism by which an increased cam ratio increases ACL injury risk and potential strategies to mitigate the increased risk posed by this bony characteristic.

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