ORLANDO -- Among professional football players who sustain injuries and require orthopedic surgery, those whose injuries involved tendons and ligaments fared worse than those with trauma to bones, a researcher reported here.
For example, among athletes who underwent patellar tendon repairs, only 50% were able to return to play, while open reduction-internal fixation of upper extremity long bone fractures had the highest rate of return to play, at 96.3%, according to Harry Mai, an MD candidate at Charles Drew/University of California Los Angeles Medical Education Program in Manhattan Beach, Calif.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"The physical nature of football exposes National Football League (NFL) athletes to the highest rate of injury in professional sports," he said at the American Academy of Orthopaedic Surgery annual meeting.
"In a league where careers average only 3.8 years, the importance of returning an athlete to a high level of performance after surgery cannot be overstated," he said.
The literature on outcomes following orthopedic surgery in injured athletes is limited and subject to bias.
Therefore, in order to establish a comprehensive database of orthopedic procedures among NFL players, Mai and colleagues compiled extensive return-to-play and performance-based outcomes before and after surgery for the years 2003 to 2013. Cases were identified through public records, with at least two independent sources to compare pathology and procedures.
A total of 559 athletes were included. Procedures in the analysis were anterior cruciate ligament (ACL) reconstruction, Achilles tendon repair, patellar tendon repair, cervical disc surgery, lumbar discectomy, sports hernia repair, knee microfracture, open reduction-internal fixation of radius, ulna, and ankle, and intramedullary nailing of lower extremity long bone fractures.
The overall rate of return to play was 79.4%. Other procedures that were associated with higher rates of return to play were sports hernia repair, at 90.2%, and tibia intramedullary nailing, at 90.9%.
Logistic regression analysis identified a weak negative correlation with return to play for age (r2 =0.081, P=0.03) and years of experience (r2 =0.084, P<0.001).
The average time for recovery from the date of surgery to the first regular season NFL game was 339 days. Procedures that were associated with more extensive recovery periods were patella tendon repair, at 391 days, ACL reconstruction, at 378 days, and Achilles tendon repair, at 375 days.
In contrast, expedited recovery times were seen for sports hernia repair (229 days) and forearm open reduction-internal fixation (232 days).
In terms of games played after the surgery, the overall average was 35.8 games, with fewer games for players who had Achilles and patellar tendon repairs, at 27 and 29 games, respectively.
There also were significant differences in career survival, with a median of only 1.1 years after patella tendon repair compared with a median of 2.2 years for tibia intramedullary nailing.
In addition, sustained decreases in performance were seen in the seasons following the procedure for ACL reconstruction and patella tendon repair.
"The data presented in this study are meant to serve as an evidence-based guide for team physicians to provide expectations after surgery," Mai said.
"These are elite athletes whose livelihoods depend upon return to sport, and these data represent the 'gold standard' for orthopedic care, as these athletes receive the most extensive and top level of care," he told 51˶.
Amateur athletes may also find these data helpful, but outcomes may differ as non-professionals may not have equivalent resources or the time to dedicate to rehabilitation, and at times, surgery may not be the best option, he explained.
"Multiple papers have demonstrated the shear forces on the knee joint that NFL athletes are subject to, especially on artificial turf. In a reconstructed tendon, these shear forces can lead to failure as well as reduction in speed, change of direction, and cutting ability," he said.
Furthermore, "the use of anabolic steroids, a known risk for this population, can subject tendons to rupture," he added.
Limitations of the study included the possibility of inaccurate reporting in publicly available sources and selection bias, with some players receiving more extensive coverage.
Disclosures
Mai disclosed no relevant relationships with industry. Some co-authors disclosed relevant relationships with Amedica, Biomet, Cytonics, DePuy, Nocimed, Pacira, Relievant, Springer, Stryker, Trinity Orthopaedics, AONA, Bacterin, Bioventus, CeramTec, Globus, Graftys, Lifenet, Medtronic, Pioneer, SI Bone, Synthes, and Ulrich Medical.
Primary Source
American Academy of Orthopaedic Surgeons
Mai H, et al "The NFL Orthopaedic Surgery Outcomes Database: the impact on careeer of common orthopaedic procedures" AAOS 2016; Paper 841.