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Bergstein VE, Agarwal AR, Solon LF, Mikula JD, Best MJ, LaPorte DM. Epidemiologic trends in hand injuries in the National Football League from 2009-2010 to 2019-2020. PHYSICIAN SPORTSMED 2024; 52:400-406. [PMID: 37994029 DOI: 10.1080/00913847.2023.2286942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES In American football, hand injuries have been shown to negatively impact performance. The purpose of this study is to characterize the prevalence and severity of hand injuries in National Football League (NFL) players. METHODS A public online database was utilized to identify hand injuries in NFL players from 2009-2010 to 2019-2020. The primary outcome was to analyze the overall incidence of hand injuries (including wrist, metacarpus, finger, and thumb), injury type by each aforementioned anatomic location, and player position. Injury severity was evaluated based on percentage of injuries in which players returned to play (RTP), number of games missed before RTP, and the percentage of injuries resulting in the player being placed on injured reserve (IR). RESULTS Of the 6,127 players included, 847 (13.8%) players sustained a hand injury, of which 24.8%, 34.3%, 17.9%, and 22.9% occurred at the wrist, metacarpus, finger, and thumb, respectively. Of the injured players, 97.4% returned to play following their injury, 14.8% were put on IR, and an average of 1.7 (SD 3.3) games were missed. Quarterbacks were the most likely to sustain hand injuries at all anatomic locations. Wrist injuries were associated with the lowest RTP rate (93.3%), the most players placed on injured reserve (28.6%), and the greatest number of games missed (mean 2.5, SD 4.2). CONCLUSION Hand injuries decreased in prevalence by 65.6% over the 11 NFL seasons evaluated. This trend coincides with the implementation of several safety rules that relate to components of play involving the hands. Quarterbacks experienced the greatest prevalence and severity for all hand injuries. Wrist injuries represent the anatomic location associated with the greatest severity. These findings may be able to inform tailored injury prevention practices by position, and advocate for the further adoption of safety rules to protect players from further injury.
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Affiliation(s)
- Victoria E Bergstein
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Lorenzo F Solon
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob D Mikula
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dawn M LaPorte
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bergstein VE, Lu AZ, Hodgens BH, Bodendorfer BM, DeFroda SF, Kaplan J, Aiyer AA. Fantasy football points capture performance declines in National Football League offensive skill players following an ankle injury. J Orthop 2024; 52:124-128. [PMID: 38596620 PMCID: PMC10999692 DOI: 10.1016/j.jor.2024.03.030] [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] [Received: 02/24/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background The ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance. Methods An open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance. Results 303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029). Conclusion Assessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL.
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Affiliation(s)
| | - Amy Z. Lu
- Weill Cornell Medical College, New York, NY, USA
| | - Blake H. Hodgens
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | | | - Steven F. DeFroda
- Missouri Orthopaedic Institute, University of Missouri Healthcare, Columbia, MO, USA
| | - Jonathan Kaplan
- Duke Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
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Kuhn AW, Coughlin MJ, McGonegle SJ, Herzog MM, Weir N, Meade Spratley E, O'Cain CM, Anderson RB. Distal Tibiofibular Syndesmosis Injuries in the National Football League (NFL): A Spectrum of Pathology That Correlates With Time to Return to Full Participation. Sports Health 2024:19417381241253223. [PMID: 38804171 DOI: 10.1177/19417381241253223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. HYPOTHESIS In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. RESULTS There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). CONCLUSION In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.
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Affiliation(s)
- Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Michael J Coughlin
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Shane J McGonegle
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Mackenzie M Herzog
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Nate Weir
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - E Meade Spratley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Cody M O'Cain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Robert B Anderson
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
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Bergstein VE, Shu HT, Bodendorfer BM, DeFroda S, Aiyer AA. Multiple Ankle Injuries Are Associated With an Increased Risk of Subsequent Concussion in National Football League Players. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231213372. [PMID: 38058976 PMCID: PMC10697033 DOI: 10.1177/24730114231213372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background There is a gap in the literature regarding musculoskeletal risk factors for concussion within the National Football League (NFL), which is an avenue that must be explored to promote player safety given the high incidence of both injury types. This study aims to observe if ankle injuries are associated with an increased risk of subsequent concussion in NFL players. Methods The public online database ProFootballReference.com was used to identify ankle injuries and concussions in NFL players from the 2009-2010 to 2019-2020 seasons. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for body mass index (BMI), age, and player position. For descriptive statistics, unpaired t tests with unequal variance were performed for continuous variables, including BMI and age. χ2 testing was performed for categorical variables, including player position, and whether the position was offensive, defensive, or on special teams. Results Of the 5538 NFL players included in the study, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72-1.14, P = .387); however, the aOR for concussion following multiple ankle injuries was 2.87 (95% CI 1.23-6.75, P = .015). Special teams players had the lowest risk for concussion (aOR 0.17, 95% CI 0.069-0.36, P < .001) following ankle injury, and there was no significant difference in risk between offense and defense (aOR 0.91, 95% CI 0.77-1.08, P = .295). Conclusion Multiple ankle injuries were associated with an increased risk of a subsequent concussion after adjusting for BMI; player position; and offense, defense, or special teams designation. These findings can inform injury prevention practices in the National Football League. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
| | - Henry T. Shu
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven DeFroda
- Missouri Orthopaedic Institute, University of Missouri Healthcare, Columbia, MO, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
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