Anterior Cruciate Ligament Reconstruction Practice Patterns by NFL and NCAA Football Team Physicians
There are currently 32 teams in the National Foot- ball League (NFL) and 123 National Collegiate Athletic Association (NCAA) Division I Football Bowl Subdivision (FBS) college football teams. This totals nearly 12,000 elite players annually (1,696 NFL roughly 53 players per team and 10,400 NCAA roughly 85 players per team). Further, the number of participants in elite-level football continues to rise with the increasing number of NFL and NCAA teams. The total revenue in 2011 for the NFL alone was $9 billion, whereas for the NCAA it was 871 million. There are approximately 400 to 500 knee injuries each year. These numbers are proportionately higher than for other sports because football players are at significant risk for both contact and noncontact injuries.
There are more than 200,000 ACL tears occurring annually in the general population of the United States. Dragoo recently showed the incidence of anterior cruciate ligament (ACL) tears in NCAA athletes to be 1.42 per 10,000 athletic exposures (defined as 1 student athlete participating in 1 practice or competition in which there was the possibility for athletic injury, regardless of the duration of that participation). The optimal ACL reconstruction technique for these elite athletes has yet to be definitively determined. Although Bradley did determine that most (84%) NFL team physicians use bone-patellar tendonebone (BTPB) autografts in their ACL reconstructions, this study did not address femoral tunnel drilling or single-versus double-bundle techniques, as well as several other technique points. Controversy still exists as to the ideal technique to treat both high-level and recreational athletes. The elite football athletes we chose to conduct a survey about were running backs. Of all the positions in football, running backs change direction the quickest and sustain the greatest amount of contact while doing so.
NFL players who have sustained an ACL tear have performed well on return to sport, although the rate of return to sport has been less than optimal.7 However, because the majority of patients who experience ACL tears are recreational athletes, it is important to elucidate how prominent team orthopaedic surgeons address ACL tears in their recreational athletes as well as their elite athletes.
The purpose of this study was to determine practice patterns for NFL and NCAA Division I football team orthopaedic surgeons regarding management of ACL tears in elite, young, and middle-aged recreational athletes. We hypothesized that BTPB autografts would be the most commonly chosen graft in starting running backs, using a single-bundle technique. We also hypothesized that surgeons would permit athletes to return to sport without a brace at a minimum of 6 months after surgery, with a normal physical examination and after successfully completing a structured battery of return-to-play tests. Finally, we hypothesized that BPTB grafts would be used much more commonly in elite athletes compared with recreational athletes.
Full Article: Anterior Cruciate Ligament Reconstruction Practice Patterns by NFL and NCAA Football Team Physicians
