Daniel B. Gibbs

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. Level of Evidence: 3

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.

Superior Labrum Anterior-Posterior Tears in the National Football League

Background: Shoulder disorders are common in football players, with up to 50% of National Football League (NFL) recruits reporting a history of shoulder injuries. Superior labrum anterior-posterior (SLAP) tears are an entity with well-described detrimental effects on return to play in overhead-throwing athletes but with minimal data in contact athletes. Purpose: To identify the incidence, predisposing factors, and effect of SLAP tears in NFL athletes and prospects as well as the treatment patterns of NFL team physicians. Study Design: Descriptive epidemiology study. Methods: This study was a comprehensive analysis of SLAP tears in elite football players using a dual approach: (1) SLAP injuries recorded in the NFL Injury Surveillance System from 2000 to 2014 were evaluated by player position, type of play, days/games lost, and surgical intervention; (2) NFL Scouting Combine athletes from 2003 to 2011 with prior SLAP repair were evaluated for draft success, and drafted athletes were compared with matched controls for career length and performance scores. Results: SLAP tears represented a small portion (3.1%) of shoulder injuries in NFL athletes from 2000 to 2014, occurring most commonly in offensive linemen (28%). Surgically treated SLAP tears (42%) resulted in more days missed than did nonoperatively managed tears (140.2 vs 21.5 days; P < .001) and more games missed (8.4 vs 2.6 games; P = .003). SLAP repairs were also rare in NFL Combine athletes (n = 25 of 2965 athletes), with most having been performed in offensive linemen (32%). As compared with control NFL Combine athletes without SLAP tears, those drafted into the NFL with prior SLAP repair played significantly fewer games (33.7 vs 48.3; P = .049) and had fewer game starts (19.6 vs 35.4; P = .036). Conclusion: In this comprehensive analysis of SLAP tears in elite football players, it is clear that these injuries have the potential to cause significant detriment to an athlete’s career.

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.

Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes

Background: A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players. Hypothesis: Preexisting rotator cuff tears decrease a player’s draft status, performance, and longevity in the NFL. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Medical reports of prospective NFL players during the NFL Scouting Combine from 2003 to 2011 were evaluated to identify players with a previous rotator cuff tear. Athletes were matched to control draftees without documented shoulder pathology by age, position, year drafted, and round drafted. Career statistics and performance scores were calculated. Results: Between 2003 and 2011, 2965 consecutive athletes were evaluated. Forty-nine athletes had preexisting rotator cuff tears: 22 athletes underwent surgical intervention for their tear and 27 were treated nonoperatively. Those with a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs 77.5%, P = 0.002). The 27 drafted athletes with preexisting rotator cuff tears started significantly fewer games (23.7 vs 43.0, P = 0.02) and played significantly fewer years (4.3 vs 5.7, P = 0.04) and significantly fewer games (47.1 vs 68.4, P = 0.04) than matched control athletes without rotator cuff tears. Conclusion: Athletes with a preexisting rotator cuff tear were less likely to be drafted and had decreased career longevity.

Performance-Based Outcomes after Operative Management of Athletic Pubalgia / Core Muscle Injury in National Football League Players

Objectives: Athletic pubalgia is a condition in which there is an injury to the core musculature that precipitates groin and lower abdominal pain, particularly in cutting and pivoting sports. These are common injury patterns in the National Football League (NFL); however, the effect of surgery on performance for these players has not been described. Methods: Athletes in the NFL that underwent a surgical procedure for athletic pubalgia / core muscle injury (CMI) were identified through team injury reports and archives on public record since 2004. Outcome data was collected for athletes who met inclusion criteria which included total games played after season of injury / surgery, number of Pro Bowls voted to, yearly total years and touchdowns for offensive players and yearly total tackles sacks and interceptions for defensive players. Previously validated performance scores were calculated using this data for each player one season before and after their procedure for a CMI. Athletes were then matched to control professional football players without a diagnosis of athletic pubalgia by age, position, year and round drafted. Statistical analysis was used to compare pre-injury and post-injury performance measures for players treated with operative management to their case controls. Results: The study group was composed of 32 NFL athletes who underwent operative management for athletic pubalgia that met inclusion criteria during this study period, including 18 offensive players and 16 defensive players. The average age of athletes undergoing this surgery was 27 years old. Analysis of pre- and post-injury athletic performance revealed no statistically significant changes after return to sport after surgical intervention; however, there was a statistically significant difference in the number of Pro Bowls that affected athletes participated in before surgery (8) compared to the season after surgery (3). Analysis of durability, as measured by total number of games played before and after surgery, revealed no statistically significant difference. Conclusion: National Football League players who undergo operative care for athletic pubalgia have a high return to play with no decrease in performance scores when compared to case-matched controls. However, the indications for operative intervention and the type of procedure performed are heterogeneous. Further research is warranted to better understand how these injuries occur, what can be done to prevent their occurrence, and the long term career ramifications of this disorder.

Pre-existing rotator cuff tears as a predictor of outcomes in national football league athletes

Objectives: Fifty percent of all athletes at the National Football League (NFL) Combine report having had a shoulder injury at some point during their playing career. Rotator cuff tears are rare injuries in young athletes, but an increasing incidence has been noted amongst competitive football players. It is unknown how pre-existing rotator cuff tears affect career longevity and performance of NFL athletes. In Combine athletes with pre-existing rotator cuff tears, knowledge of outcomes may help athletes and physicians manage expectations of draft potential, career length and performance. Methods: The written medical evaluations of prospective professional American football athletes from 2003-2011 during the NFL Combine were compiled and evaluated. All players were evaluated for the diagnosis of a pre-existing rotator cuff tear and stratified based on whether or not they underwent surgical intervention. Athletes with rotator cuff tears, who were selected in the NFL draft, were matched by age, position, year, and round drafted to control draftees without significant documented shoulder pathology. Career statistics, including a previously established “Performance Score,” were compiled. The continuous variables of each cohort were compared using a Students t-test. A Chi Squared test was performed to analyze the categorical data. Statistical significance was accepted with a p-value < 0.05. Results: Between the years of 2003 and 2011, 2,965 consecutive athletes were evaluated. Forty-nine athletes were identified with a pre-existing rotator cuff tear; twenty-two of these athletes underwent surgical intervention for their tear and 27 were treated non-operatively. Those who attended the NFL Combine with a history of a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs. 77.5% respectively, p = 0.002) (Table 1A). The 27 drafted athletes with pre-existing rotator cuff tears played significantly fewer years (4.3 vs. 5.7, p=0.04) and significantly fewer games (47.1 vs. 68.4, p=0.04) than matched control athletes without rotator cuff tears (Table 1B). Additionally, these athletes started significantly fewer games (23.7 vs. 43.0, p=0.02) and had significantly worse performance scores (0.97 vs. 1.33, p=0.01) when compared to controls. When comparing those who had surgical intervention on their rotator cuff tears with those treated non-operatively, there were no statistically significant differences identified in outcome measures, including round drafted (3.7 vs. 4.8, p=0.17) and performance score (0.18 vs. 1.36, p=0.16) (Table 1C). Conclusion: NFL athletes with pre-existing rotator cuff tears were less likely to be drafted. Those drafted had decreased career longevity as well as diminished career performance when compared to matched control players. Additionally, athletes who had previous surgical intervention on a torn rotator cuff trended toward a worse draft status and career performance score, but these results were not statistically significant. Players with rotator cuff tears, regardless of whether or not they had surgery, demonstrated significantly shortened careers and decreased performance scores compared to players without rotator cuff tears. These results will help both players and physicians at the NFL Combine manage expectations of draft potential, career longevity and success.

Lumbar Spine Injury/Pathology as a Predictor of Outcomes in National Football League Athletes

Objectives: The purpose of this study is to determine if a pre-existing lumbar diagnosis such as spondylosis, a herniated lumbar disc, or spondylolysis affects a football player’s draft status or his performance and longevity in the NFL. Methods: The written medical evaluations and imaging reports of prospective professional American football athletes from 2003-2011 from one NFL franchise during the NFL combine (annual college football player evaluation prior to the NFL draft) were compiled and evaluated. All players were evaluated for a pre-existing lumbar diagnosis which were compiled from previous injury/medical records including radiographic imaging reports. Those players with a lumbar spine diagnosis and with appropriate radiograph, MRI and CT imaging were included in this study. These athletes were then matched by age, position, year, and round drafted to control draftees without a lumbar spine diagnosis. Career statistics were compiled including length of play and number of games started. Additionally, a previously established “Performance Score” was calculated for all players excluding offensive linemen. The continuous variables of each cohort were compared using a two-sided (tailed) Student’s t-test for normally distributed data. A chi-squared analysis was performed to analyze the categorical data. Statistical significance was accepted with a p < 0.05. Results: Out of a total of 2,965 athletes evaluated from the NFL combine, 414 players were identified with a pre-existing lumbar spine diagnosis. Athletes who attended the NFL combine without a lumbar spine diagnosis were significantly more likely to be drafted than those with one (74% vs. 61% respectively, p < 0.01). There was no difference between the investigational and control group with regard to round drafted, age, year drafted, or position. Overall, athletes with a lumbar spine injury compared to the control group had no difference in the number of years played (4.0 vs. 4.3 years, respectively, p = 0.13), games played (46.5 vs. 50.7, respectively, p = 0.15), games started (28.1 vs. 30.6, respectively, p = 0.39) or performance score (1.4 vs. 1.8, respectively, p = 0.3) (Figure 1). Conclusion: The data in this study suggests that a pre-existing lumbar spine diagnosis was associated with a significantly lower draft status for NFL athletes. However, the data in our study suggests that such a diagnosis did not affect a player’s career longevity or performance. Further study will be required to determine the individual effects of specific conditions on performance.