Effect of shoulder stabilization on career length in national football league athletes

Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players

Background

Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career.

Hypothesis

The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up.

Study Design

Cohort study; Level of evidence, 3.

Methods

The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification).

Results

The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis.

Conclusion

The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

Association of Injury Rates Among Players in the National Football League With Playoff Qualification, Travel Distance, Game Timing, and the Addition of Another Game: Data From the 2017 to 2022 Seasons

Background

Injury incidence is higher in the National Football League (NFL) than in other collision sports. Although previous research has identified that scheduling variations, including overseas games and bye week timing, does not affect concussion risk, data are currently lacking regarding the effects of scheduling variation on season-long musculoskeletal injury incidence.

Purpose

To determine whether higher cumulative travel distance, overseas play, an early season bye week, and an expansion of the regular season is associated with higher injury rates in the NFL.

Study Design

Descriptive epidemiology study.

Methods

All 1275 injuries across 5 NFL seasons from 2017 to 2018 through 2021 to 2022 were reviewed retrospectively. Injury data and travel distances were extracted from publicly available sources, which were cross-referenced for validation. Injury rates were calculated per 1000 athletic-exposures (AEs). Cumulative team travel distances were compared statistically using a linear regression. Single factor analysis of variance was used to compare categorical variables.

Results

Travel distance did not significantly predict injury rates (P = .47), and there was no difference in injury rates between teams that played a game overseas versus teams that did not (19.3 injuries per 1000 AEs for both; P = .96). In addition, no difference was found in injury rates (F[109,2100[ = 0.704; P = .73) or players placed on the injured reserve list (F[99,778] = 1.70; P = .077) between various bye weeks (P = .73). Injury rates did not differ between the new 17-game regular season (18.4 per 1000 AEs) versus the previous four 16-game regular seasons (19.7 per 1000 AEs; P = .12). However, teams that did not qualify for the playoffs had a significantly higher injury rate (19.9 per 1000 AEs) as well as players on injured reserve (8.0 per 1000 AEs) than playoff-qualifying teams (18.4 and 6.8 per 1000 AEs, respectively; P < .05 for both).

Conclusion

Over 5 NFL seasons, cumulative travel distance, overseas play, bye week timing, and adding 1 regular season game were not associated with increased injury rates in NFL players. However, a lack of regular season success was associated with higher injury rates and more players on injured reserve.

Player Position and Labral Tear Location and Size in NCAA Division I Football Players Undergoing Arthroscopic Surgery

Background:

Shoulder instability attributed to glenoid labral tears is common among National Collegiate Athletic Association (NCAA) football players. Certain repetitive activities by player position may contribute to instability.

Purpose:

To compare the location of labral tears among player positions in NCAA Division I football.

Study Design:

Cross-sectional study.

Methods:

We conducted a review of football players who underwent shoulder labral repair between 2000 and 2020 at a single institution. Inclusion criteria were NCAA Division I level, diagnosis of shoulder instability, and labral tear requiring arthroscopic repair. Exclusion criteria were prior surgery on injured shoulder and incomplete medical records. Players were divided into 3 groups: line players (offensive and defensive linemen, defensive end), skill players (defensive back, wide receiver, running back, and quarterback), and hybrid players (linebacker and tight end). Labral tear location and size were recorded using the clockface method and categorized into 6 zones: superior, anterosuperior, anteroinferior, inferior, posteroinferior, and posterosuperior. Comparison of variables was performed using chi-square test or Fisher exact test (categorical) and 1-way analysis of variance or Kruskal-Wallis H test (continuous). The Spearman rank-order correlation was used to assess relationships between continuous data.

Results:

Of the 53 included players, 37 (70%) were offensive linemen, defensive linemen, and linebackers. There were 29 line players, 11 skill players, and 13 hybrid players. Line players represented 55% of included players and had the most total labral tears as compared with all groups. Hybrid players had a significantly higher percentage of posterosuperior tears than line players (92% vs 52%; P = .015) and skill players (92% vs 27%; P = .002). Skill players had a significantly higher percentage of anterior tears at 3:00-4:00 and 5:00-6:00 when compared with hybrid players (82% vs 15%, P = .003; 82% vs 31%, P = .012, respectively). There was a positive correlation between labral tear size and number of suture anchors (0; P = .010).

Conclusion:

In this study of NCAA Division I football players, skill players had a higher proportion of anteroinferior labral tears, and hybrid players had a higher proportion of posterosuperior labral tears.

Successful Outcomes and Return to Sport After Arthroscopic Bankart Repair in National Collegiate Athletic Association and National Football League Football Players

OBJECTIVE

To characterize recurrent instability, return to sport (RTS), and patient-reported outcomes (PROs) after arthroscopic Bankart repair for acute traumatic anterior shoulder instability in National Collegiate Athletic Association (NCAA) and National Football League (NFL) football players.

DESIGN

Case series.

SETTING

Orthopaedic and sports medicine clinic.

PARTICIPANTS

National Collegiate Athletic Association and NFL football athletes with traumatic anterior shoulder instability who underwent arthroscopic shoulder stabilization at a single institution with at least 2-year follow-up.

INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES

Arthroscopic Bankart repair.

MAIN OUTCOME MEASURES

Recurrent instability, RTS, patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score.

RESULTS

Thirty-three players were included with a mean age of 23.8 years (range, 18-33 years) and a mean follow-up of 6.3 years (range, 4.1-9.3 years). One shoulder (3.0%) had a postoperative subluxation event, and 1 shoulder (3.0%) required revision surgery for issues other than instability; 93.3% of players were able to RTS at the same level or higher for at least 1 season. Mean satisfaction was 8.9 ± 2.3. Mean VAS was 1.0 ± 1.7, and mean ASES and Rowe scores were 90.7 ± 18.5 and 89.7 ± 15.2, respectively.

CONCLUSION

Arthroscopic Bankart repair is an effective surgical intervention for traumatic anterior shoulder instability in NCAA and NFL football players. At a mean 6-year follow-up, surgery restored stability in 97% of cases and 93.3% returned to their preinjury level of sport.

Validity of Research Based on Public Data in Sports Medicine: A Quantitative Assessment of Anterior Cruciate Ligament Injuries in the National Football League

BACKGROUND

Numerous researchers have leveraged publicly available Internet sources to publish publicly obtained data (POD) studies concerning various orthopaedic injuries in National Football League (NFL) players.

PURPOSE

To provide a comprehensive systematic review of all POD studies regarding musculoskeletal injuries in NFL athletes and to use anterior cruciate ligament (ACL) injuries in NFL players to quantify the percentage of injuries identified by these studies.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic review was conducted to identify all published studies utilizing POD regarding ACL injury in NFL athletes from 2000 to 2019. Data regarding player demographics were extracted from each publication. These results were compared with prospectively collected data reported by the teams' medical staff to the NFL Injury Surveillance System database linked to the League's electronic health record. An ACL "capture rate" for each article was calculated by dividing the number of ACL injuries in the POD study by the total number of ACL injuries in the NFL injury database occurring in the study period of interest.

RESULTS

A total of 42 studies were extracted that met the definition of a POD study: 28 evaluated a variety of injuries and 14 dealt specifically with ACL injuries, with 35 (83%) of the 42 studies published during or since 2015. POD studies captured a mean of 66% (range, 31%-90%) of ACL injuries reported by the teams' medical staff. This inability to capture all injury rates varied by position, with 86% capture of ACL injuries in skill athletes, 72% in midskill athletes, and 61% in linemen. POD studies captured 35% of injuries occurring during special teams play.

CONCLUSION

The frequency of studies leveraging publicly obtained injury data in NFL players has rapidly increased since 2000. There is significant heterogeneity in the degree to which POD studies correctly identify ACL injuries from public reports. Sports medicine research relying solely on publicly obtained sources should be interpreted with an understanding of their inherent limitations and biases. These studies underreport the true incidence of injuries, with a bias toward capturing injuries in more popular players.

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes

BACKGROUND

Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes.

PURPOSE

To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated.

RESULTS

This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002).

CONCLUSION

Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

Glenoid Bone Loss Is a Risk Factor for Poor Clinical Results After Coracoid Transfer in Rugby Players With Shoulder Dislocations

Background:

Although surgical shoulder stabilization via coracoid transfer in collision athletes is effective and has a low reinjury rate, the factors affecting poor clinical results and the superiority of the 2 stabilization procedures (Bristow and Latarjet) remain unclear.

Purpose:

To explore the factor(s) affecting poor clinical results of coracoid transfer in a large cohort of rugby players and to compare postoperative function between the Bristow and Latarjet procedures.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 169 consecutive shoulders of 154 competitive male rugby players who underwent shoulder stabilization surgery (Bankart repair with coracoid transfer) between 2014 and 2018 and had a mean follow-up of 2.7 years (minimum follow-up, 2 years). The Bristow procedure was performed in the first 92 shoulders (84 players), and the Latarjet procedure was performed in the latter 77 shoulders (70 players). A poor clinical result was defined as a postoperative Rowe score of <70 and a postoperative Western Ontario Shoulder Instability Index (WOSI) score of >630. Multiple logistic regression analysis was conducted to identify the factors affecting postoperative functional failure. The postoperative scores and complication rates were also compared between the 2 procedures.

Results:

In total, 92.3% of the rugby players returned to their preinjury competition level at a mean of 5.9 months postoperatively. The Rowe and WOSI scores showed that shoulder function was improved postoperatively compared with preoperatively. The number of rugby players with a poor clinical result was 18 (10.7%). Multiple logistic regression analysis demonstrated that a poor clinical result was associated with a preoperative glenoid bone defect of >20% of the glenoid width (odds ratio, 9.8), whereas the clinical result was unaffected by the type of coracoid transfer. There were no differences between the 2 procedures in any of the postoperative scores or complication rates.

Conclusion:

The present study indicated that the most effective predictor of postoperative functional scores was the degree of the glenoid bone defect and not the type of coracoid transfer. This information may be useful for the strategic treatment of shoulder dislocations in collision athletes.

The glenohumeral ligaments: Superior, middle, and inferior: Anatomy, biomechanics, injury, and diagnosis

The three glenohumeral ligaments (superior, middle, and inferior) are discrete thickenings of the glenohumeral joint capsule and are critical to shoulder stability and function. Injuries to this area are a cause of significant musculoskeletal morbidity. A literature search was performed by a review of PubMed, Google Scholar, and OVID for all relevant articles published up until 2020. This study highlights the anatomy, biomechanical function, and injury patterns of the glenohumeral ligaments, which may be relevant to clinical presentation and diagnosis. A detailed understanding of the normal anatomy and biomechanics is a necessary prerequisite to understanding the injury patterns and clinical presentations of disorders involving the glenohumeral ligaments of the shoulder.

Return to play and performance after shoulder instability in National Basketball Association athletes

HYPOTHESIS

We hypothesized that players in the National Basketball Association (NBA) who sustained a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type.

METHODS

We used publicly available data to identify and evaluate 50 players who sustained an in-season shoulder instability event (subluxation/dislocation) while playing in the NBA. Demographic variables, return to NBA gameplay, incidence of surgery, time to RTP, recurrent instability events, and player efficiency rating (PER) were collected. Overall RTP was determined, and players were compared by type of injury and mode of treatment.

RESULTS

All players (50/50) returned to game play after sustaining a shoulder instability event. In those treated nonoperatively, athletes who sustained shoulder subluxations returned after an average of 3.6 weeks, compared with 7.6 weeks in those who sustained a shoulder dislocation (P = .037). Players who underwent operative management returned after an average of 19 weeks. Athletes treated operatively were found to have a longer time interval between a recurrent instability event (70 weeks vs. 28.5 weeks, P = .001).

CONCLUSION

We found 100% rate of RTP after a shoulder instability event in an NBA athlete. Players who experience shoulder dislocations were found to miss more time before RTP and were more likely to undergo surgical intervention compared with those who experienced a subluxation. Surgical repair maintained a longer interval between recurrent instability. Future investigations should aim to evaluate outcomes based on surgical procedures and identify possible risk factors predictive of recurrent instability or failure to RTP.

A Systematic Review of the Orthopaedic Literature Involving National Football League Players

Background

Orthopaedic injuries of National Football League (NFL) players can have a deleterious effect on their health, with minimal to no high-level evidence on the management of these injuries.

Purpose

To summarize all data published between January 1980 and March 2018 on orthopaedic injuries experienced by NFL candidates and professional players in the NFL.

Study Design

Systematic review; Level of evidence, 4.

Methods

A literature search of studies examining orthopaedic injuries in the NFL was performed through the PubMed, Embase, and CINAHL databases. The review included studies of orthopaedic injuries in college football recruits attending the NFL Combine as well as professional NFL players. Excluded were studies of nonorthopaedic injuries, such as concussions, traumatic brain injury, facial injuries, and vascular injuries, as well as case reports.

Results

A total of 147 articles met the inclusion criteria and were divided into 11 topics based on anatomic site: general (16%), spine (13%), shoulder (13%), elbow (3%), hand and wrist (3%), trunk (0.7%), hip and pelvis (7%), thigh (3%), knee (24%), ankle (5%), and foot (12%). Of these studies, 74% were of level 4 evidence. Most studies obtained data from the NFL Combine database (26%), by searching the internet (24%), and via the NFL Injury Surveillance System (22%). Studies using internet search methods to identify injuries consistently found fewer participants than studies using the NFL Injury Surveillance System.

Conclusion

This systematic review provides National Collegiate Athletic Association and NFL team physicians with a single source of the most current literature regarding orthopaedic injuries in NFL players. Most research was published on knee, spine, shoulder, and foot injuries and consisted of level 4 evidence. A substantial portion of the published literature was based on data obtained from internet searches and may not accurately represent the NFL population.

The impact of prior upper-extremity surgery on orthopedic injury and surgery in collegiate athletes

BACKGROUND

The influence of prior upper-extremity (UE) surgery on a collegiate athletic career is poorly understood. This study aimed to investigate the impact of prior UE surgery on participation, injury, and surgery rates in collegiate athletes.

METHODS

Division I athletes who commenced collegiate athletics from 2003-2009 were retrospectively identified. Pre-participation evaluation forms were queried for the history of pre-collegiate UE surgery. Data on sport played, seasons played, injuries, days missed, and orthopedic imaging and surgical procedures were collected through athletic and medical records and compared with those of athletes without prior UE surgery. Subgroup analysis was performed for shoulder surgery, elbow surgery, and wrist and/or hand surgery.

RESULTS

Between 2003 and 2009, 1145 athletes completed pre-participation evaluations. Of these athletes, 77 (6.7%) underwent at least 1 pre-collegiate UE surgical procedure. Prior UE surgery was most common in men's water polo (15.0%), baseball (14.9%), and football (12.6%). The UE surgery group had a higher rate of collegiate UE injury (hazard ratio, 4.127; P < .01) and missed more days per season because of UE injury (16.5 days vs. 6.7 days, P = .03) than controls. Athletes with prior shoulder surgery (n = 20) also experienced more UE injuries compared with controls (hazard ratio, 15,083; P = .02). They missed more days per season (77.5 days vs. 29.8 days, P < .01), underwent more magnetic resonance imaging scans (0.96 vs. 0.40, P < .01), and underwent more orthopedic surgical procedures per season (0.23 vs. 0.08, P < .01). The elbow subgroup and wrist and/or hand subgroup were comparable with controls on all measures.

CONCLUSIONS

Collegiate athletes with prior shoulder surgery missed more days and underwent more magnetic resonance imaging scans and surgical procedures in college, whereas those with prior elbow surgical procedures and wrist and/or hand surgical procedures were comparable with controls.

Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes

PURPOSE

Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93-98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated.

METHODS

73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII). Patients were analyzed using shoulder sport-specific measurement tools for sport ability (ASOSS), sport activity (SSAS), and numerical analog scales: NAS_{pain during sport}, NAS_{shoulder function in sport}, and NAS_{re-achievement of sport level}. Four points of examination were established: preoperative evaluation (FU0) and first postoperative follow-up (FU1) at 6 months; FU2 at 12 months; and FU3 at 24 months after surgery. The control group (GIII) consisted of 140 healthy athletes without anamnesis of prior macro-injury or surgery.

RESULTS

After surgical stabilization, 29 of 35 athletes in GI (82.9%; 38.6 ± 9.9 years) and 32 of 38 in GII (82.9%; 38.6 ± 9.9 years) were followed up for 24 months (FU3) (loss 17.8%). All operated athletes showed significantly increased scores compared to FU0 (p < 0.05). Compared to GI, GII showed significantly superior outcome data for sporting ability as well as for NAS_{re-achievement of sport level} (p < 0.05). While GII re-achieved GIII-comparable SSAS and ASOSS levels, GI remained at a significantly inferior level. Athletes after ACJ injury of Rockwood grade IV/V and overhead athletes benefited significantly from the dDSB procedure.

CONCLUSION

The dDSB procedure enabled significantly superior sport-specific outcomes compared to the cHP procedure. Athletes after dDSB surgeries re-achieved the sporting ability and the sport activity levels of healthy athletes, whereas athletes after cHP implantation remained at significantly inferior levels. The more extensive dDSB procedure and the more restrictive rehabilitation are recommended for treatment of acute high-grade ACJ separations of functionally high-demanding athletes.

LEVEL OF EVIDENCE

I.

Characteristics of Operative Shoulder Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014

Background:

Injuries to the upper extremity among collegiate athletes are reported to account for approximately 20% of all injuries; however, little is known about the proportion of these injuries that require surgery.

Purpose/Hypothesis:

The purpose of this study was to examine all shoulder injuries that required a surgical intervention and were recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). We hypothesized that contact would be the mechanism causing injuries most at risk for needing surgery and that dislocations would be the injuries most likely to require an operative intervention.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Injury surveillance data between 2009-2010 and 2013-2014 for operative collegiate shoulder injuries and their associated sport exposures were analyzed.

Results:

A total of 185 operative shoulder injuries occurred over 3,739,004 athlete-exposures (AEs), for an overall incidence of 0.49 per 10,000 AEs. The sports with the highest incidence of operative injuries were men’s football (1.31/10,000 AEs), men’s wrestling (1.14/10,000 AEs), men’s ice hockey (0.60/10,000 AEs), women’s gymnastics (0.44/10,000 AEs), and men’s swimming (0.41/10,000 AEs). Men were significantly more likely than women to sustain operative injuries for all sports combined. Of the injuries that required surgical treatment, superior labrum from anterior to posterior (SLAP) tears (46.4%), other non-SLAP glenoid labrum tears (46.2%), anterior shoulder dislocations (33.3%), and posterior shoulder dislocations (30.0%) were seen most often. There was no significant difference in injury proportion ratios (IPRs) for injuries requiring surgery when comparing contact versus noncontact mechanisms of injury (IPR, 1.0 [95% CI, 0.6-1.6]). The incidence of operative injuries sustained during competition was significantly higher compared with during practice.

Conclusion:

The sports with the highest incidence of operative shoulder injuries were men’s football, men’s wrestling, men’s ice hockey, and women’s gymnastics. Operative shoulder injuries were more likely to occur during competition. SLAP tears, other non-SLAP glenoid labrum tears, and anterior shoulder dislocations had the highest incidence of requiring surgery. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from identifying collegiate sport participants who are at highest risk for sustaining an operative injury. This may assist in planning medical care and setting expectations, which may be critical to a young athlete’s career.

Effect of Anterior Glenoid Labral Tears and Glenoid Bone Loss at the NFL Combine on Future NFL Performance

Background:

Anterior glenohumeral instability is a common abnormality in the young, athletic population, especially in those participating in contact or collision sports.

Purpose:

To examine the effect of anterior labral tears, their associated injuries, and their management on future National Football League (NFL) performance.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective review of all NFL Combine participants from 2009 to 2015 was performed using medical and imaging reports compiled at the NFL Combine. These notes and images were reviewed and analyzed for involved structures, associated injuries, and evidence of previous surgical interventions. The respective NFL draft position, number of NFL games played, number of NFL games started, and NFL snap percentage for each player’s first 2 seasons were collected and compared with a control group and within subgroups.

Results:

Of the 2285 players at the NFL Combine between 2009 and 2015, there were 206 (9%) anterior labral tears confirmed by magnetic resonance imaging, 20 of which were bilateral, for a total of 226 affected shoulders. There were 908 players who fit the criteria for inclusion in the control group. Overall, there were no significant differences between players with anterior labral tears and the control players in terms of draft position (P = .259), games played in their first 2 NFL seasons (P = .391), games started in their first 2 NFL seasons (P = .486), or snap percentage in their first (P = .268) and second (P = .757) NFL seasons. In general, sustaining a concomitant injury with an anterior labral tear (superior labrum from anterior to posterior [SLAP] tear, glenoid bone loss, Hill-Sachs lesion, rotator cuff tear, humeral avulsion of the glenohumeral ligament, and anterior tear combined with posterior tear) negatively affected a player’s NFL draft position when compared with those with an isolated anterior labral tear (P = .003). There was no significant difference between operative and nonoperative management for anterior labral tears in terms of any performance metric.

Conclusion:

A history of anterior labral tears was not significantly associated with future NFL performance. While players with isolated injuries were drafted significantly earlier than those with concomitant injuries, combined injuries did not affect players’ games played, games started, or snap percentage in their first 2 NFL seasons. Glenoid bone loss did significantly decrease draft position; however, the severity of bone loss did not affect draft position, and there were no significant associations between glenoid bone loss and games played, games started, or snap percentage.

Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014

BACKGROUND

Examination of the incidence of shoulder season-ending injury (SEI) in the collegiate athlete population is limited.

PURPOSE

To determine the incidence of shoulder SEI in the National Collegiate Athletic Association (NCAA) and to investigate the risk factors for a shoulder injury ending an athlete's season.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All shoulder injuries from the NCAA Injury Surveillance Program database for the years 2009-2010 to 2013-2014 were extracted, and SEI status was noted. The incidences of SEI and non-SEI were calculated for athlete, activity, and injury characteristics and compared via univariable analysis and risk ratios to determine risk factors for an injury being season ending.

RESULTS

Shoulder injuries were season ending in 4.3% of cases. The overall incidence of shoulder SEI was 0.31 per 10,000 athlete exposures (AEs), as opposed to 7.25 per 10,000 AEs for all shoulder injuries. Shoulder instability constituted 49.1% of SEI, with an incidence of 0.15 per 10,000 AEs, while fractures had the highest rate of being season ending (41.9%). Men's wrestling had the highest incidence of shoulder SEI (1.65 per 10,000 AEs), while men's soccer had the highest proportion of shoulder injuries that ended a season (14.6%). Overall, men had a 6.3-fold higher incidence of SEI than women and a 2.4-fold increased likelihood that an injury would be season ending.

CONCLUSION

Injury to the shoulder of an NCAA athlete, while somewhat infrequent, can have significant implications on time lost from play. Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. Athletes sustaining potentially season-ending shoulder injuries, with their coaches and medical providers, may benefit from these data to best manage expectations and outcomes.

Midterm Clinical Results in Rugby Players Treated With the Bristow Procedure

BACKGROUND

Although surgical shoulder stabilization by coracoid transfer is effective for collision athletes and has a low reinjury rate, no reports have described the midterm results of this procedure in specific patient cohorts of sufficient number or provided subjective assessments of these patients.

PURPOSE

To evaluate midterm results after treatment of shoulder instability with the Bristow procedure in a large cohort of rugby players.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This study included 176 shoulders of 152 competitive rugby players who underwent shoulder stabilization surgery (Bristow procedure with Bankart repair) with a mean follow-up of 4 years (minimum of 2 years) in our institute. The primary outcome measure was the difference in the presurgical and postsurgical functional Rowe score and Western Ontario Shoulder Instability index (WOSI) score and factors affecting these scores. Complication rates and associated factors were also investigated.

RESULTS

In total, 176 shoulders of 152 patients underwent the Bristow procedure with Bankart repair, and 93.2% of the players returned to their preinjury competition level at a mean of 6.3 months postoperatively. All Rowe and WOSI scores were significantly improved after surgery. The numbers of shoulders with functional failure as indicated by the Rowe score, WOSI score, and inability to return to the previous level of play were 28 (15.9%), 54 (30.7%), and 12 (6.8%), respectively. Multiple logistic regression analyses demonstrated that reinjury after surgery (odds ratio [OR] = 35.1) and the number of shoulder dislocations (OR = 11.2-11.4) negatively affected the competition level after return to play, while reinjury (OR = 11.1-17.8), the number of shoulder subluxations (OR = 1.1-2.9), injury in the dominant shoulder (OR = 1.2-2.2), and large bone defects (OR = 1.1-11.5) negatively affected functional scores. Reinjury after shoulder stabilization occurred in 6 of 176 shoulders (3.4%). Multiple logistic regression analysis demonstrated that reinjury after surgery occurred more frequently in players at lower versus higher grade levels of competition (OR = 21.0). Although differences were not significant, a trend was noted toward higher postoperative reinjury rates in forward players, those in the upper categories (professional and college), and those with injury in the nondominant shoulder.

CONCLUSION

The Bristow procedure provides good midterm outcomes for competitive collision athletes, while postsurgical reinjury, the number of preoperative dislocations and subluxations, and large bone defects negatively affect postsurgical shoulder function. This information may be useful for treatment of shoulder dislocations in collision athletes.

Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes

PURPOSE

To investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL).

METHODS

Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine.

RESULTS

A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n = 39 athletes, n = 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P = .032). Prospective participation in the NFL in terms of games played (P = .38) or started (P = .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of degenerative joint disease.

CONCLUSIONS

Athletes invited to the NFL Scouting Combine with a history of bilateral repair, posterior labral repair, and concomitant shoulder pathology are at high risk of recurrent labral tearing on MRI. No significant reduction in NFL participation the year after the Combine was seen in athletes with a history of labral repair, recurrent labral tearing, or degenerative joint disease who were successfully drafted into the NFL. In athletes with a history of labral repair, assessment of labral integrity on MRI alone is not predictive of future short-term participation.

LEVEL OF EVIDENCE

Level IV, prognostic study-case series.

Editorial Commentary: MRI Findings Are Only One Part of the Equation in National Football League Athletes: Shoulder Instability in Contact Athletes

Shoulder instability is a common problem in contact sports such as the National Football League. Although many elite level football athletes will have shoulder magnetic resonance imaging (MRI) findings consistent with labral tearing on MRI, these imaging findings are not always correlated with symptomatic instability or functional limitations. It is crucial in all patients, not just National Football League athletes, to treat the patient, and not the MRI.

Return to play after shoulder instability in National Football League athletes

HYPOTHESIS

We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type.

METHODS

We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared.

RESULTS

Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050).

CONCLUSION

There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event.

Characteristics and Outcomes of Arthroscopic Femoroacetabular Impingement Surgery in the National Football League

BACKGROUND

Previous studies have reported that hip abnormalities may account for 10% of injuries in professional football players. The effect of femoroacetabular impingement (FAI) and arthroscopic FAI surgery in National Football League (NFL) athletes has not been well studied.

PURPOSE

To investigate the effect of arthroscopic FAI surgery on return to play (RTP) and RTP performance in NFL players.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

NFL athletes undergoing arthroscopic FAI surgery at a single institution between 2006 and 2014 were identified. Medical records were reviewed for demographic, clinical, and operative variables. RTP and RTP performance were assessed based on a review of publicly available NFL player statistics. RTP and RTP performance data included time to RTP; games played before and after the injury; yearly total yards and touchdowns for offensive players; and yearly total tackles, sacks, and interceptions for defensive players. The offensive power rating (OPR = [total yards/10] + [total touchdowns × 6]) and defensive power rating (DPR = total tackles + [total sacks × 2] + [total interceptions × 2]) were calculated. Paired t tests comparing preinjury and postinjury seasons were performed. A matched cohort of NFL players was created to compare trends for OPR, DPR, and career longevity.

RESULTS

Forty-eight hips in 40 NFL players (mean age, 25.6 years) with symptomatic FAI were included; 8 players underwent staged bilateral hip arthroscopic procedures. The majority of players were offensive (n = 24; 60.0%), with offensive lineman (n = 11; 27.5%) being the most common of all positions. Of the 48 included hips, all had labral tears, and 41 (85.4%) underwent labral repair. Forty-two of the 48 hips (87.5%) underwent cam decompression, and 10 (20.8%) underwent rim decompression. Of the 40 included players, 37 (92.5%) achieved RTP to professional competition after their hip arthroscopic surgery at a mean of 6.0 months. Before the injury, included patients played in a mean of 11.0 games compared with 9.5 games in their postoperative season ( P = .26). The mean OPR and DPR demonstrated a nonsignificant decline in the postoperative season (preinjury OPR, 40.2; postinjury OPR, 32.3; P = .34) (preinjury DPR, 49.6; postinjury DPR, 36.4; P = .10). A similar decline in the OPR and DPR across seasons was observed in the control group. NFL athletes played, on average, 3.3 ± 1.5 seasons after undergoing hip arthroscopic surgery; this was not significantly different from the controls (2.5 ± 1.5 seasons; P = .47). There was no significant difference in mean annual salaries based on contracts negotiated before the injury and the first negotiated contract after surgery ($3.3 million vs $3.6 million, respectively; P = .58).

CONCLUSION

There was a very high rate of RTP in the NFL after arthroscopic FAI surgery; this rate is higher than what has been previously reported for other orthopaedic procedures in NFL athletes. Additionally, these NFL athletes achieved RTP at a faster time frame (6 months) than previously reported for other procedures. These findings have important implications for counseling elite football players about the expected outcome of arthroscopic FAI surgery.

Professional Athletes' Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture

BACKGROUND

Most Achilles tendon ruptures are sports related. However, few studies have examined and compared the effect of surgical repair for complete ruptures on return to play (RTP), play time, and performance across multiple sports.

PURPOSE

To examine RTP and performance among professional athletes after Achilles tendon repair and compare pre- versus postoperative functional outcomes of professional athletes from different major leagues in the United States.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

National Basketball Association (NBA), National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2013 were identified via public injury reports and press releases. Demographic information and performance-related statistics were recorded for 2 seasons before and after surgery and compared with matched controls. Statistical analyses were used to assess differences in recorded metrics.

RESULTS

Of 86 athletes screened, 62 met inclusion criteria including 25 NBA, 32 NFL, and 5 MLB players. Nineteen (30.6%) professional athletes with an isolated Achilles tendon rupture treated surgically were unable to return to play. Among athletes who successfully returned to play, game participation averaged 75.4% ( P < .001) and 81.9% ( P = .002) of the total games played the season before injury at 1 and 2 years postoperatively, respectively. Play time was significantly decreased and athletes performed significantly worse compared with preoperative levels at 1 and 2 years after injury ( P < .001). When players were compared with matched controls, an Achilles tendon rupture resulted in fewer games played ( P < .001), decreased play time ( P = .025), and worse performance statistics ( P < .001) at 1 year but not 2 years postoperatively ( P > .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance.

CONCLUSION

An Achilles tendon rupture is a devastating injury that prevents RTP for 30.6% of professional players. Athletes who do return play in fewer games, have less play time, and perform at a lower level than their preinjury status. However, these functional deficits are seen only at 1 year after surgery compared with matched controls, such that players who return to play can expect to perform at a level commensurate with uninjured controls 2 years postoperatively.

The Latarjet Procedure at the National Football League Scouting Combine: An Imaging and Performance Analysis

Background:

The Latarjet procedure is commonly performed in the setting of glenoid bone loss for treatment of recurrent anterior shoulder instability; however, little is known regarding the outcomes of this procedure in elite American football players.

Purpose:

(1) Determine the prevalence, clinical features, and imaging findings of elite college football athletes who present to the National Football League (NFL) Combine with a previous Latarjet procedure and (2) describe these athletes’ performance in the NFL in terms of draft status and initial playing time.

Study Design:

Case series; Level of evidence, 4.

Methods:

After review of all football players who participated in the NFL Combine from 2009 to 2016, any player with a previous Latarjet procedure was included in this study. Medical records, position on the field, and draft position were recorded for each player. In addition, imaging studies were reviewed to determine fixation type, hardware complications, and status of the bone block. For those players who were ultimately drafted, performance was assessed based on games played and started, total snaps, and percentage of eligible snaps in which the player participated during his rookie season.

Results:

Overall, 13 of 2617 (<1%) players at the combine were identified with a previous Latarjet procedure. Radiographically, 8 of 13 (61%) showed 2-screw fixation, while 5 of 13 (39%) had 1 screw. Of the 13 players, 6 (46%) players demonstrated hardware complications. All players had evidence of degenerative changes on plain radiographs, with 10 (77%) graded as mild, 1 (8%) as moderate, and 2 (15%) as severe according to the Samilson Prieto classification. Six of the 13 (46%) players went undrafted, while the remaining 7 (54%) were drafted; however, no player participated in more than half of the plays for which he was eligible during his rookie season.

Conclusion:

Only a small percentage of players at the NFL Combine (<1%) had undergone a Latarjet procedure. High rates of postoperative complications and radiographically confirmed degenerative change were observed. Athletes who had undergone a Latarjet procedure demonstrated a variable amount of playing time, but none participated in more than half of their eligible plays during their rookie season.

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete's Prospective NFL Career

Background:

Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function.

Purpose:

To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years.

Results:

Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group (P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group (P = .02).

Conclusion:

A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low prevalence of navicular injury in prospective NFL players was noted, players with these injuries had a greater probability of not being drafted and not competing in at least 2 NFL seasons when compared with matched controls without an injury history to the NFL Combine.

Epidemiology of Operative Procedures in an NCAA Division I Football Team Over 10 Seasons

Background:

Injury rates are high for collegiate football players. Few studies have evaluated the epidemiology of surgical procedures in National Collegiate Athletic Association (NCAA) Division I collegiate football players.

Purpose:

To determine the most common surgical procedures performed in collegiate football players over a 10-year period.

Study Design:

Descriptive epidemiological study.

Methods:

From the 2004-2005 season through the 2013-2014 season, all surgical procedures performed on athletes from a single NCAA Division I college football team during athletic participation were reviewed. Surgeries were categorized by anatomic location, and operative reports were used to obtain further surgical details. Data collected over this 10-season span included type of injury, primary procedures, reoperations, and cause of reoperation, all categorized by specific anatomic locations and position played.

Results:

From the 2004-2005 through the 2013-2014 seasons, 254 operations were performed on 207 players, averaging 25.4 surgical procedures per year. The majority of surgeries performed were orthopaedic procedures (92.1%, n = 234). However, there were multiple nonorthopaedic procedures (7.9%, n = 20). The most common procedure performed was arthroscopic shoulder labral repair (12.2%, n = 31). Partial meniscectomy (11.8%, n = 30), arthroscopic anterior cruciate ligament (ACL) reconstruction (9.4% n = 24), and arthroscopic hip labral repair (5.9% n = 15) were the other commonly performed procedures. There were a total of 29 reoperations performed; thus, 12.9% of primary procedures had a reoperation. The most common revision procedure was a revision open reduction internal fixation of stress fractures in the foot as a result of a symptomatic nonunion (33.33%, n = 4) and revision ACL reconstruction (12.5%, n = 3). By position, relative to the number of athletes at each position, linebackers (30.5%) and defensive linemen (29.1%) were the most likely to undergo surgery while kickers (6%) were the least likely.

Conclusion:

In NCAA Division I college football players, the most commonly performed surgeries conducted for injuries were orthopaedic in nature. Of these, arthroscopic shoulder labral repair was the most common, followed closely by partial meniscectomy. Nonorthopaedic procedures nonetheless accounted for a sizable portion of surgical volume. Familiarity with this injury and surgical spectrum is of utmost importance for the team physician treating these high-level contact athletes.

Common Shoulder Injuries in American Football Athletes

American football is a collision sport played by athletes at high speeds. Despite the padding and conditioning in these athletes, the shoulder is a vulnerable joint, and injuries to the shoulder girdle are common at all levels of competitive football. Some of the most common injuries in these athletes include anterior and posterior glenohumeral instability, acromioclavicular pathology (including separation, osteolysis, and osteoarthritis), rotator cuff pathology (including contusions, partial thickness, and full thickness tears), and pectoralis major and minor tears. In this article, we will review the epidemiology and clinical and radiographic workup of these injuries. We also will evaluate the effectiveness of surgical and nonsurgical management specifically related to high school, collegiate, and professional football athletes.

The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association

BACKGROUND

Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes' careers.

PURPOSE

To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries.

RESULTS

A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m(2) (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures.

CONCLUSION

NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures.

Management of In-Season Concurrent Rotator Cuff Tear With Shoulder Instability in Professional Contact Football Athletes; Respect the Career Goals!

Introduction

Professional sports injuries are usually all dealt with at one single operation to return the player to the sport after appropriate rehabilitation. We questioned the assumption that rotator cuff tears must be repaired concurrently with instability syndromes, and aimed to allow a professional rugby league player to achieve career goals by NOT correcting all pathology at one surgery.

Case Presentation

A professional rugby league player presented with acute shoulder instability on a setting of a chronic full thickness rotator cuff tear. We performed an “in season” arthroscopic stabilization on an elite rugby league player, leaving a previously diagnosed large full thickness rotator cuff tear untreated. This allowed aggressive rehabilitation and return to contact competition at 12 weeks post-surgery. The player achieved a long held career goal of winning a premiership ring before undertaking rotator cuff repair at the end of the season. Latest follow up at seven years (still at elite level) demonstrated an asymptomatic shoulder.

Conclusions

The assumption that all pathology found at surgical exploration requires correction to play at elite level is not universally correct. We postulate that whilst rotator cuff deficiency has severe long-term sequelae, it is shoulder instability alone that prevents high level contact sports participation. Career goal management is an important part of managing elite level athletes. We have demonstrated that by careful management of the specific pathology preventing participation can allow elite athletes to achieve career goals without compromising long-term health.

Incapacity of work after arthroscopic Bankart repair

BACKGROUND AND INTRODUCTION

The incapacity with respect to work following anterior-inferior shoulder dislocation and subsequent Bankart repair has not been previously examined. The objective of this study was to examine a patient's incapacity according to the classification by the REFA Association. The recovery time was measured and the outcome of patients with heavy workload was compared to those with lower workloads.

MATERIALS AND METHODS

A total of 74 patients who underwent isolated arthroscopic Bankart repair fulfilled the inclusion criteria. The Constant-Murley Score, UCLA Shoulder Score and ROWE Score for Shoulder Instability were recorded for clinical assessment. The mean follow-up time was 43.1 months (SD ± 17.4; 24-110 months) with a mean age of 34.7 years (SD ± 12.6). Workload was classified as per the REFA Association classification system. Postoperative duration of a patient's incapacity with respect to work and other subjective ratings were provided by the patients themselves.

RESULTS

The mean incapacity of work was 2.73 months (95 % CI 1.19-5.36). The incapacity of work was 2.06 months (95 % CI 1.55-2.68) in the group with low physical strains at work (REFA 0-1) and 3.40 months (95 % CI 2.70-4.24) in the group with heavy workload (REFA 2-4/p = 0.005). Overall, the mean Constant-Murley Score was 87.7 (SD ± 13.5). The average UCLA Shoulder Score summed up to 31.9 (SD ± 3.87) and the mean ROWE Score was 87.6 (SD ± 21.7). 13 (17.5 %) patients had problems to compete in their jobs. Three patients had to change the job postoperatively.

CONCLUSION

In this study, a relationship between the time of incapacity of work and the workload was observed; patients with low physical strains returned significantly earlier to work after arthroscopic Bankart repair (p = 0.005). In general, the clinical results as measured in the Constant/UCLA/Rowe score were comparable to other studies.

Pre-existing lumbar spine diagnosis as a predictor of outcomes in National Football League athletes

BACKGROUND

It is currently unknown how pre-existing lumbar spine conditions may affect the medical evaluation, draft status, and subsequent career performance of National Football League (NFL) players.

PURPOSE

To determine if a pre-existing lumbar diagnosis affects a player's draft status or his performance and longevity in the NFL.

STUDY DESIGN

Cohort study; Level 3.

METHODS

The investigators evaluated the written medical evaluations and imaging reports of prospective NFL players from a single franchise during the NFL Scouting Combine from 2003 to 2011. Players with a reported lumbar spine diagnosis and with appropriate imaging were included in this study. Athletes were then matched to control draftees without a lumbar spine diagnosis by age, position, year, and round drafted. Career statistics and performance scores were calculated.

RESULTS

Of a total of 2965 athletes evaluated, 414 were identified as having a pre-existing lumbar spine diagnosis. Players without a lumbar spine diagnosis were more likely to be drafted than were those with a diagnosis (80.2% vs. 61.1%, respectively, P < .001). Drafted athletes with pre-existing lumbar spine injuries had a decrease in the number of years played compared with the matched control group (4.0 vs. 4.3 years, respectively, P = .001), games played (46.5 vs. 50.8, respectively, P = .0001), and games started (28.1 vs. 30.6, respectively, P = .02) but not performance score (1.4 vs. 1.8, respectively, P = .13). Compared with controls, players were less likely to be drafted if they had been diagnosed with spondylosis (62.37% vs. 78.55%), a lumbar herniated disc (60.27% vs. 78.43%), or spondylolysis with or without spondylolisthesis (64.44% vs. 78.15%) (P < .001 for all), but there was no appreciable effect on career performance; however, the diagnosis of spondylolysis was associated with a decrease in career longevity (P < .05). Notably, 2 athletes who had undergone posterior lateral lumbar fusion were drafted. One played in 125 games, and the other is still active and has played in 108 games.

CONCLUSION

The data in this study suggest that athletes with pre-existing lumbar spine conditions were less likely to be drafted and that the diagnosis is associated with a decrease in career longevity but not performance. Players with lumbar fusion have achieved successful careers in the NFL.

The impact of a cervical spine diagnosis on the careers of National Football League athletes

STUDY DESIGN

Cohort study.

OBJECTIVE

To determine the effect of cervical spine pathology on athletes entering the National Football League.

SUMMARY OF BACKGROUND DATA

The association of symptomatic cervical spine pathology with American football athletes has been described; however, it is unknown how preexisting cervical spine pathology affects career performance of a National Football League player.

METHODS

The medical evaluations and imaging reports of American football athletes from 2003 to 2011 during the combine were evaluated. Athletes with a cervical spine diagnosis were matched to controls and career statistics were compiled.

RESULTS

Of a total of 2965 evaluated athletes, 143 players met the inclusion criteria. Athletes who attended the National Football League combine without a cervical spine diagnosis were more likely to be drafted than those with a diagnosis (P = 0.001). Players with a cervical spine diagnosis had a decreased total games played (P = 0.01). There was no difference in the number of games started (P = 0.08) or performance score (P = 0.38). In 10 athletes with a sagittal canal diameter of less than 10 mm, there was no difference in years, games played, games started, or performance score (P > 0.24). No neurological injury occurred during their careers. In 7 players who were drafted with a history of cervical spine surgery (4 anterior cervical discectomy and fusion, 2 foraminotomy, and 1 suboccipital craniectomy with a C1 laminectomy), there was no difference in career longevity or performance when compared with matched controls.

CONCLUSION

This study suggests that athletes with preexisting cervical spine pathology were less likely to be drafted than controls. Players with preexisting cervical spine pathology demonstrated a shorter career than those without; however, statistically based performance and numbers of games started were not different. Players with cervical spinal stenosis and those with a history of previous surgery demonstrated no difference in performance-based outcomes and no reports of neurological injury during their careers.

Management of the athlete with a failed shoulder instability procedure

The athlete with a failed instability procedure requires a thoughtful and systematic approach to achieve a good outcome. Goals of treatment should be defined and realistic expectations should be set. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. Fundamental to successful revision surgery is choosing the correct procedure. The decision is straightforward in athletes with clear factors that predict recurrence (significant glenoid bone loss, engaging Hill-Sachs lesions) because only a bony procedure can restore the articular arc of the glenoid. Arthroscopic revision Bankart repair may be appropriate in those athletes who have an obvious Bankart tear and no bone loss after a traumatic reinjury. The challenge for the shoulder surgeon is identifying the best surgery for the athlete who does not have such clear-cut indications. Each factor that has the potential to lead to a poor outcome needs to be collected and calculated. Patient factors (age, laxity, type and level of sport), injury factors (mechanism of injury, capsulolabral injury, glenoid bone loss, Hill-Sachs lesion), and technical factors (previous surgery performed, integrity of repair, scarring) must be integrated into the treatment algorithm. Based on this collection of factors, the shoulder surgeon should be prepared to provide the athlete with the surgery that provides the best chance to return to playing sports and the lowest risk of recurrent instability.

Radiographic factors and effect of fifth metatarsal Jones and diaphyseal stress fractures on participation in the NFL

INTRODUCTION

Jones fracture and proximal diaphyseal stress fracture of the fifth metatarsal have been associated with prolonged healing times and nonunions. We hypothesized that the Jones fracture and proximal diaphyseal stress fracture have a high incidence in elite collegiate football players and that they lead to a decrease in participation in the NFL. Also, we hypothesized that these fractures are associated with a cavovarus foot alignment.

MATERIALS AND METHODS

The database collected by a single NFL team during the 2004 to 2009 NFL Combines was reviewed to identify players with Jones and proximal diaphyseal fifth metatarsal fractures. A total of 74 fifth metatarsal fractures were identified in 68 players. Subsequent participation data also were collected through the NFL.com website and included games played and years played. Digital plain radiographs and additional imaging studies also were reviewed to determine the extent of healing, types of fixation utilized, and foot alignment.

RESULTS

The locations of fractures in the proximal fifth metatarsal were 45 (61%) in the Jones area, 15 (20%) in the proximal diaphyseal area, and 14 (19%) of indeterminate location. The number of patients treated with intramedullary fixation was 55/74 (74%). Of 74 proximal fifth metatarsal fractures, 9 (12.2%) were nonunions at the time of the NFL Combine medical examinations. With the numbers available, the average number of games played in the NFL was not significantly different in the fifth metatarsal fracture group, 16.9, compared to the control group, 24.9 (P > .05). The average number of games started was 7.4 in the fracture group versus 12.1 in the control group (P > .05). No significant differences were noted in the number of years played in the NFL. Except for talonavicular angle measurements, all measurements of coronal plane alignment demonstrated significant differences across groups, but no differences were noted in sagittal plane alignment.

CONCLUSION

No statistically significant difference was noted in participation in the NFL following Jones fractures and proximal diaphyseal stress fractures of the fifth metatarsal, although a trend toward decreased participation was noted. Radiographic abnormalities were noted in the coronal plane with varus alignment, but not in the sagittal plane.

Imaging of football injuries to the upper extremity

Imaging of football players is unique in many ways. Familiarity with mechanisms of injury, position of the player, and the need for rapid diagnosis and reporting will help radiologists when dealing with these athletes. Although plain radiographs are typically the first imaging modality used, MR imaging has become the cornerstone on which diagnoses and treatment decisions are based. As these athletes become stronger, faster, and more skilled, the ability to accurately assess their injuries becomes even more important, and understanding of the challenges that these patients present becomes critical.

Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment

BACKGROUND

Reports of return to shoulder-dependent sport after surgical stabilization previously underestimated impairments, which were not reflected in the score systems used.

HYPOTHESIS

Return to shoulder-dependent sport depends on the type of sport performed.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Forty-seven athletes (26.9 years of age at surgery) who underwent isolated arthroscopic Bankart repair were longitudinally monitored by shoulder-dependent sport-specific activity (Shoulder Sport Activity Score [SSAS]) and ability (Athletic Shoulder Outcome Scoring System [ASOSS]) scores and visual analog scales for reachieved proficiency level, sport-specific shoulder pain, and functional deficits. Data were assessed at 4 points of treatment: preoperatively, and postoperatively after 6, 16, and 32 months (P0-P3). Athletes were analyzed separately according to shoulder sport: noncollision/nonoverhead (G1), collision (G2), overhead (G3), and martial arts (G4).

RESULTS

The G1 and G2 athletes had re-achieved the preinjury sport activity and sport proficiency status and excellent ASOSS scores after 32 months (SSAS(G1) = 7.2, SSAS(G2) = 8.1, ASOSS(G1) = 94.4, ASOSS(G2) = 95.2), whereas G3 and G4 athletes remained at an inferior activity level (SSAS(G3) = 8.0, SSAS(G4) = 8.3) and proficiency level. The ASOSS documented a prolonged period of shoulder rehabilitation for G3 and G4 athletes to reach a good shoulder-dependent sport ability outcome after 32 months (ASOSS(G3) = 89.0, ASOSS(G4) = 93.1). All groups recorded persisting limitations in visual analog scales for sport-specific shoulder function and pain. The established scores (Rowe = 95.9, Walch-Duplay = 93.3, Constant = 94.0) did not reflect these sport-specific impairments. Athletes with 5 or more preoperative dislocations had significantly longer surgery-to-sport resumption intervals with a prolonged proficiency recovery.

CONCLUSION

The athletes' shoulder stabilization resulted in a prolonged rehabilitation depending on the functional demand of the performed shoulder-dependent sport, as shown by the specific shoulder sport score systems.