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

Abstract

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

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

“…3 In a review of NFL combine participants with a prior ACL injury, Connor et al found a 25% incidence of a subsequent second ACL injury (12 ipsilateral and 14 contralateral) during their NFL career, which was significantly greater than the incidence of primary ACL injury among a healthy, matched control cohort (18/200 ¼ 9%; P < .001). 7 The results from the present study demonstrated that from a cohort of NFL athletes who played in NFL games prior to their first ACL reconstruction and successfully returned to play for at least half of an NFL season, 28.9% (13/45) sustained a second ACL injury, with approximately equal distribution of reinjury and contralateral injury (54% vs 46%). Although these results show a greater incidence of subsequent injury than prior literature, it is likely secondary to the stringent inclusion criteria applied.…”

“…8 Additionally, athletes with a history of ACL reconstruction have a higher likelihood of suffering a contralateral ACL injury. [7][8][9] The work of Paterno et al identified the psychological toll of a primary ACL injury and subsequent reconstruction as a significant factor in increasing the risk of a second ACL tear, 10 while the fear of suffering a reinjury, in turn, places a great psychological toll on athletes as well. 11,12 Given the decrease in average career lifespan of NFL players to approximately 3 seasons, 13 from 4.6 seasons a decade ago, 14 the potential of an ACL injury to negatively affect the longevity and performance of an NFL career can be a concern for athletes and organizations.…”

“…Among NFL athletes entering the NFL with a history of ACL reconstruction, there is an approximately 25% incidence of players who sustain a second ACL injury during their NFL career. 3 , 7 When considering athletes overall following an ACL injury, prior literature suggests that the rate of retear or reinjury requiring a revision reconstruction can be up to 6 times higher in a group of athletes that had already underwent an ACL reconstruction compared with healthy controls. 8 Additionally, athletes with a history of ACL reconstruction have a higher likelihood of suffering a contralateral ACL injury.…”

“… 8 Additionally, athletes with a history of ACL reconstruction have a higher likelihood of suffering a contralateral ACL injury. 7 , 8 , 9 The work of Paterno et al. identified the psychological toll of a primary ACL injury and subsequent reconstruction as a significant factor in increasing the risk of a second ACL tear, 10 while the fear of suffering a reinjury, in turn, places a great psychological toll on athletes as well.…”

Anterior Cruciate Ligament Reconstruction Does Not Impact Career Earnings After Return to Play in National Basketball Association Athletes

“…17 It has been reported that among NFL players, ACL reinjury occurs at a rate of 25%, which is notably higher than the reported 11.8% incidence in NBA players. 10,18 Finally, it has been found that although NBA players are reported to reach preinjury baseline performance by the second season after RTP, NFL players exhibit reduced performance for 3 seasons after RTP. 6 These factors contribute to the retained earnings after RTP from ACL reconstruction in NBA athletes.…”