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Dupont MM, Fourman MS, Iyer S, Qureshi SA, Sheha ED, Rhie-Lee J, Dowdell J. Impact of Lumbar Disk Herniation on Performance Outcomes and New Contracts in the National Football League. Clin Spine Surg 2023; 36:E139-E144. [PMID: 36127776 DOI: 10.1097/bsd.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To determine performance outcomes and the contract-signing ability for the most recent cohort of professional football players treated for lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA LDH can have a significant impact on the career of a National Football League (NFL) player. Previous studies have found favorable return to play (RTP) and performance outcomes for players with LDH, but the impact on the ability to sign new contracts (an important surrogate to assess continued success) has not previously been studied. MATERIALS AND METHODS NFL players treated for LDH from 2000 to 2020 were identified from a public records search. Age, position, type of treatment, and RTP measures were collected. Pro Football Focus (PFF) performance grade and contract values were compared before the injury and after treatment. Multivariable logistic regression was used to identify independent risk factors associated with the ability to RTP and sign high-value contracts. RESULTS One hundred one players were treated for an LDH, of which 75 returned to play. Posttreatment performance as measured by PFF was similar to preinjury levels ( P =0.2). However, both total and guaranteed contract values were significantly reduced ( P <0.01). In multivariable analysis, both lower age and higher preinjury PFF grade were independent predictors of RTP and ability to sign a new contract. A preinjury contract that contained a high proportion of guaranteed money was found to be an independent predictor of the ability to sign a contract that was >20% guaranteed. CONCLUSION Although the majority of players were able to RTP at preserved performance levels following LDH treatment, their contract values were significantly reduced. RTP and contract-signing ability were not associated with the type of treatment, but rather baseline factors such as the player's age, performance, and preinjury compensation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Sravisht Iyer
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Evan D Sheha
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | - James Dowdell
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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2
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Tramer JS, Jildeh TR, Castle JP, Buckley P, Nowak C, Okoroha KR. The impact of nonoperative hip and core injuries on National Football League athlete performance. PHYSICIAN SPORTSMED 2023; 51:27-32. [PMID: 34488522 DOI: 10.1080/00913847.2021.1976603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Hip and core injuries are common in National Football League (NFL) athletes; however, the impact following injury remains unclear. The goal of this manuscript was to determine the impact of nonoperative hip and core injuries on return to play and performance. METHODS NFL athletes who sustained a hip or core injury treated nonoperatively between 2010 and 2016 were identified. Offensive and defensive power ratings were calculated for each player's injury season and two seasons before and after to assess longitudinal impact. A matched control group without an identified hip and/or core injury was assembled for comparison. RESULTS A total of 41 offensive and 71 defensive players with nonoperative hip or core injury were analyzed. All athletes returned to play; offensive and defensive players missed 4.0 ± 5.2 and 3.1 ± 2.6 games after injury, respectively. Offensive players played fewer cumulative career games returning from core injury versus hip (23.5 ± 20.6 vs 41.0 ± 26.4). Defensive players played fewer games (58.1 ± 41.1 versus 37.4 ± 27.1, p < 0.05) with lower defensive power rating (133.9 ± 128.5 versus 219.8 ± 212.2, p < 0.05) cumulatively after hip or core injury. Additionally, 2 years following injury, defensive players played fewer games compared to controls (9.5 ± 7.0 versus 10.9 ± 6.8, p < 0.05). Following hip injury specifically, NFL defenders played fewer games (39.8 ± 27.9 vs 61.9 ± 38.8; p < 0.05) and had a lower defensive power rating (145.9 ± 131.7 vs 239.0 ± 205.9; p < 0.05) compared to before injury. CONCLUSION Overall, NFL players return to play following nonoperative hip and core injuries. Defensive players played in fewer games following hip or core injury compared to controls; offensive players were unaffected. Hip injuries have a greater impact on performance compared to core injuries in defensive athletes; offensive players played fewer games upon return from core injury.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, United States
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, United States
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, United States
| | - Patrick Buckley
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, United States
| | - Caden Nowak
- Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, Minneapolis, Minnesota, United States
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Ackermann J, Saxena V, Whalen J, Mack CD, Herzog M, Probst JR, Price MD. Epidemiology of Traumatic Posterior Hip Instability in the National Football League. Orthop J Sports Med 2022; 10:23259671211067257. [PMID: 35005054 PMCID: PMC8727838 DOI: 10.1177/23259671211067257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: There is a paucity of literature regarding injury incidence, mechanism, and return to play in National Football League (NFL) players who have sustained traumatic posterior hip instability. Purpose: To describe the incidence of traumatic posterior hip instability and the rate of return to play in NFL players across 18 seasons. Study Design: Descriptive epidemiology study. Methods: We retrospectively assessed all traumatic posterior hip dislocations/subluxations that occurred during football-related activities in the NFL seasons from 2000 through 2017. Player demographics and injury data (injury mechanism, season of injury, treatment, days missed, and return to play time) were collected from all 32 NFL teams prospectively through a leaguewide electronic health record system. Descriptive statistics are presented. Results: Across the 18 NFL seasons, 16 posterior hip instability injuries in 14 players were reported, with a maximum incidence of 4 (25%) in 2013. Posterior hip instability was predominantly sustained by offensive players (64.3%), with tight ends being the most affected (31.3%). Half of the injuries occurred during the regular season, 43.8% in the preseason, and 6.2% in the offseason. Of all injuries, 37.5% were noncontact, while 56.3% involved contact (direct or indirect), and 6.2% were of unknown mechanism. Among noncontact injuries, 66.7% occurred during cutting and change of direction while sprinting. The time of return to full participation was documented for 11 of the 16 reported injuries (68.8%); among them, the mean time loss was 136.7 ± 83.8 days—143.3 ± 99.6 days if the player underwent surgery (n = 4) and 116.7 ± 76.2 days missed by players without surgery (n = 6)—the treatment modality was unknown in 1 player. Conclusion: Although the incidence of traumatic posterior hip instability during the study period was low, all injured athletes missed time from football activities and competitions. Injuries that required surgery led to more missed time than those that did not. Ongoing research to understand risk factors and mechanisms of this injury, in conjunction with improvements to prevention and rehabilitation protocols, is necessary to ensure the safety of professional American football players.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vishal Saxena
- Department of Orthopaedic Surgery and Sports Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Jim Whalen
- New England Patriots, Foxborough, Massachusetts, USA
| | | | | | | | - Mark D Price
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,New England Patriots, Foxborough, Massachusetts, USA
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Martin CL, Arundale AJH, Kluzek S, Ferguson T, Collins GS, Bullock GS. Characterization of Rookie Season Injury and Illness and Career Longevity Among National Basketball Association Players. JAMA Netw Open 2021; 4:e2128199. [PMID: 34605914 PMCID: PMC8491104 DOI: 10.1001/jamanetworkopen.2021.28199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is limited research investigating injury and illness among professional basketball players during their rookie season. By improving the understanding of injury incidence and risk specific to rookie players, sports medicine clinicians may be able to further individualize injury mitigation programs that address the unique needs of rookie players. OBJECTIVE To compare incidence and rate ratio (RR) of injury and illness among professional National Basketball Association (NBA) players in their rookie season with veteran players and to explore the association of sustaining an injury rookie season with career longevity. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used an online data repository and extracted publicly available data about NBA players between the 2007 and 2008 season to the 2018 and 2019 season. Available data for initial injury and all subsequent injuries were extracted during this time frame. EXPOSURES Injury and illness based on injury status during the rookie season of professional NBA players. MAIN OUTCOMES AND MEASURES Injury and illness incidence and RR. Association of injury during the rookie season with career longevity was assessed via Poisson regressions. RESULTS Of the 12 basketball seasons analyzed, 904 NBA players were included (mean [SD] age, 24.6 [3.9] years; body mass index, 24.8 [1.8]). The injury and illness incidence for rookie players was 14.28 per 1000 athlete game exposures (AGEs). Among all body regions, ankle injuries had the greatest injury incidence among players injured during their rookie season (3.17 [95% CI, 3.15-3.19] per 1000 AGEs). Rookie athletes demonstrated higher RR compared with veterans across multiple regions of the body (ankle: 1.32; 95% CI, 1.12 to 1.52; foot/toe: 1.29; 95% CI, 0.97 to 1.61; shoulder/arm/elbow: 1.43; 95% CI, 1.10 to 1.77; head/neck: 1.21; 95% CI, 0.61 to 1.81; concussions: 2.39; 95% CI, 1.89 to 2.90; illness: 1.14; 95% CI, 0.87 to 1.40), and demonstrated a higher rate of initial injuries compared with veteran players (1.41; 95% CI, 1.29 to 1.53). Players who sustained an injury rookie season demonstrated an unadjusted decrease in total seasons played (-0.4 [95% CI, -0.5 to -0.3] log years; P < .001), but this decrease was not observed within adjusted analysis (0.1 [95% CI, -0.1 to 0.2] log years; P = .36). CONCLUSIONS AND RELEVANCE In this study, rookie athletes demonstrated the highest injury incidence at the ankle and increased RR across multiple regions. These findings may reflect differences in preseason conditioning or load variables impacting rookie athletes and warrant further investigation. Future research is needed to determine the association of cumulative injury burden vs a singular injury event on career longevity.
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Affiliation(s)
| | - Amelia J. H. Arundale
- Icahn School of Medicine at Mount Sinai Health System, New York, New York
- Red Bull Athlete Performance Center, Red Bull GmBH, Thalgau, Austria
| | - Stefan Kluzek
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Tyler Ferguson
- Big Data Institute, University of Oxford, United Kingdom
| | - Gary S. Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Garrett S. Bullock
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Sports-Related Lisfranc Injuries and Recognition of Lisfranc Variants: Surgical Strategies for Stabilization. Foot Ankle Clin 2021; 26:13-33. [PMID: 33487236 DOI: 10.1016/j.fcl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Much has changed since Lisfranc described lesions at the tarsometatarsal (TMT) joint in 1815. What was considered an osseous high-energy condition nowadays is understood as myriad possible presentations, occurring in minor and inconspicuous traumas. Advancements in diagnostics of Lisfranc injury allow recognizing many variants of this trauma presentation, most of them with a focus on ligaments. This perception shifted trends in surgical planning, especially for implants and fixation techniques. These revolutions established a new and evolving universe around TMT lesions, different from what was known only a few years ago and still not enough to completely settle the disease scenario.
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Ter Laak Bolk CS, Dahmen J, Lambers KTA, Blankevoort L, Kerkhoffs GMMJ. Adequate return to sports and sports activities after treatment of Lisfranc injury: a meta-analysis. J ISAKOS 2020; 6:212-219. [PMID: 34272297 DOI: 10.1136/jisakos-2020-000477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/11/2020] [Accepted: 10/28/2020] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Although a large number of Lisfranc injuries occur during sports, data on sports outcomes, such as return to sport (RTS) rates and times as well as level of sports activities after treatment of this injury remain limited. OBJECTIVE The aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries. EVIDENCE REVIEW The electronic databases PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL were searched to identify relevant articles from January 1985 to July 2020. The mean RTS rates (to any level and preinjury level of sports) and times were extracted per study, and pooled wherever methodologically possible. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS). FINDINGS Fifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%). CONCLUSIONS AND RELEVANCE The different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries. LEVEL OF EVIDENCE Systematic review and meta-analysis.
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Affiliation(s)
- Carlijn S Ter Laak Bolk
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Kaj T A Lambers
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands .,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
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7
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Schroeder GD, Canseco JA, Patel PD, Hilibrand AS, Kepler CK, Mirkovic SM, Watkins RG, Dossett A, Hecht AC, Vaccaro AR. Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society. Neurosurgery 2020; 87:647-654. [DOI: 10.1093/neuros/nyaa308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/31/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies.
OBJECTIVE
To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations.
METHODS
Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes.
RESULTS
Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter >10 mm (90.5%), as well as those with resolved MRI signal changes and diameter >13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of cervical spine injury (78.9%).
CONCLUSION
This study provides modified Delphi process consensus statements regarding cervical spine injury management in collision sport athletes from leading experts in spine surgery, sports injuries, and cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.
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Affiliation(s)
- Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Parthik D Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher K Kepler
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srdjan M Mirkovic
- Northwestern Orthopaedic Institute, NorthShore University HealthSystem, Chicago, Illinois
| | | | - Andrew Dossett
- The Carrell Clinic Orthopedic and Sports Medicine, Dallas, Texas
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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