ArticlePDF Available

Acromioclavicular Joint Injuries in the National Football League Epidemiology and Management

Authors:

Abstract and Figures

Background: Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). Purpose: The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Study design: Descriptive epidemiological study. Methods: All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Results: Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost a mean of 56.2 days. Conclusion: Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than in previous investigations that evaluated these injuries during the 1980s and 1990s.
Content may be subject to copyright.
Acromioclavicular Joint Injuries
in the National Football League
Epidemiology and Management
T. Sean Lynch,
*
y
MD, Matthew D. Saltzman,
y
MD, Jason H. Ghodasra,
y
MD,
Karl Y. Bilimoria,
y
MD, Mark K. Bowen,
z
MD, and Gordon W. Nuber,
z
MD
Investigation performed at Northwestern University, Chicago, Illinois
Background: Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have
only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position play-
ers in the National Football League (NFL).
Purpose: The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players;
(2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk
for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to com-
pare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention.
Study Design: Descriptive epidemiological study.
Methods: All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS)
over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field con-
ditions, type of play, requirement of surgical management, days missed per injury, and injury incidence.
Results: Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC
joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these
injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing
plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the
incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players
(20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing
the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with
nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost
a mean of 56.2 days.
Conclusion: Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost
but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than
in previous investigations that evaluated these injuries during the 1980s and 1990s.
Keywords: National Football League (NFL); professional football; football (American); shoulder; AC joint; shoulder separations
In the sport of American football, shoulder injuries account
for 10% to 20% of all musculoskeletal injuries and are
only less common than injuries of the hand, ankle, and
knee.
1-3,5,6,9,12,13,16
Acromioclavicular (AC) joint injuries
commonly occur in contact sports via a direct blow to the
shoulder or indirectly when the player is hit or tackled
and lands on the affected shoulder. Kaplan et al
8
found
that AC joint injuries accounted for 41% of all shoulder
injuries in a cohort of intercollegiate football players. The
AC joint is a diarthrodial joint stabilized by the AC and cor-
acoclavicular ligaments. The superior and posterior AC lig-
aments prevent motion in the anteroposterior plane, while
the more robust coracoclavicular ligaments provide static
checkreins in the vertical plane. Despite the frequency of
shoulder injuries, few studies have reported the incidence
and treatment of these injuries in high-level football
players.
4,8,10,15
*
Address correspondence to T. Sean Lynch, Northwestern University,
676 North St Clair Street, Suite 1350, Chicago, IL 60611 (e-mail: tsean
lynch@gmail.com).
y
Northwestern University, Chicago, Illinois.
z
NorthShore University Health System, Evanston, Illinois.
The authors declared that they have no conflicts of interest in the
authorship and publication of this contribution.
The American Journal of Sports Medicine, Vol. XX, No. X
DOI: 10.1177/0363546513504284
Ó2013 The Author(s)
1
AJSM PreView, published on September 20, 2013 as doi:10.1177/0363546513504284
In one of the first epidemiological investigations of
shoulder injuries in the National Football League (NFL),
Kelly et al
10
found that AC joint injuries were the most
common shoulder injuries and accounted for 40% of all
shoulder injuries sustained by quarterbacks over a 22-
season period (1980-2001). Because of the nature of the
position, quarterbacks were believed to be particularly
prone to these injuries, with the majority of injuries occur-
ring during game competition rather than in the practice
setting. The most common mechanism of injury was from
either being tackled onto the playing surface or colliding
with another player. Utilizing the Rockwood classification
system for AC joint injuries, Kelly et al reported that 44%
of these injuries were type I injuries, 24% were type II, 20%
were type III, and 12% were not specified.
10
The mean time
lost from play after an AC joint injury was 22 days with
a median of 12.5 days.
10
The majority of these injuries
were treated without surgery.
The purpose of this study was 4-fold: (1) to determine
the incidence of AC joint injuries among all NFL position
players; (2) to investigate whether player position, compe-
tition setting, type of play, and playing surface were asso-
ciated with an increased risk for this type of injury; (3) to
determine the incidence of operative and nonoperative
management of these injuries; and (4) to compare the
time missed for those injuries treated nonoperatively ver-
sus the time missed for those injuries requiring surgical
intervention.
MATERIALS AND METHODS
After approval by the NFL Physician’s Society, a retrospec-
tive epidemiological review of all AC joint injuries between
2000 and 2011 (12 seasons) was performed using the NFL
Injury Surveillance System (NFLISS). This database was
established in 1980 and includes data such as the date of
injury and return to play, type of injury, type of field sur-
face, and type of injury management. These data were col-
lected and managed by Outcome Sciences Inc (Cambridge,
Massachusetts). The NFL records all injuries through the
NFLISS, with an injury being documented if (1) it resulted
in the player being removed from practice or a game or (2)
if it caused a loss of at least 1 practice, game, or training
session. Injuries that met inclusion for this study were
the following: distal clavicle contusions, AC joint sprains/
separations, and AC joint inflammation.
The AC joint separations were classified by the team
physician based on the Rockwood classification scheme
(see Appendix 1, available in the online version of this
article at http://ajsm.sagepub.com/supplemental). We
evaluated each injury for player position, playing condi-
tions (game vs practice, grass vs artificial surface), type
of play (passing play vs running play), type of manage-
ment, and total days lost due to the injury. Data were
available for whether the patient had nonoperative or sur-
gical treatment of the injury; however, specific details on
the type of surgery or surgical findings were not docu-
mented. For those athletes treated without surgery, the
database did not give specific information about what
measures were utilized (eg, corticosteroid or local anes-
thetic injections).
Information regarding each injury was based on the pri-
mary clinical diagnosis made by the team physician. The
trainer for each individual NFL team was responsible for
collecting and submitting these data to the NFLISS. The
collected information includes the diagnosis and evalua-
tion of all injuries that occurred during preseason training
camp, 4 preseason games, the regular 17-week regular sea-
son (16 games and 1 ‘‘bye week’’), and postseason-related
activities (practices, games, and scrimmages). Injuries
were either listed as occurring during the preseason or reg-
ular season (which included the playoffs). Injuries that
took place during off-season workouts were not collected
by the database. There were no follow-up examinations
available for this review. Additionally, data were analyzed
for treatment and return to play for each injury. Finally,
the mechanism of injury, type of play (running vs passing),
and playing conditions (games vs practice, natural vs arti-
ficial surface) were documented.
It should be noted that the special teams’ data required
special analysis because the only players officially listed in
this unit are punters, placekickers, and long snappers. The
NFL rosters do not delineate players from other positions
that might also be playing on the special teams’ unit to
get additional playing time. An analysis of NFL team ros-
ters from 2000 to 2011 revealed that there were 202
punters, placekickers, and long snappers designated on
official NFL team rosters. During any given special teams
situation, there are 9 other athletes on the field with this
unit. As a result, it was determined that 9 ‘‘special teams’’
players should be added to each of the NFL teams during
these 12 seasons.
Categorical variables were compared with the x
2
test.
Positional exposure risk (PER) was calculated to correct
the total injury count for the number of exposures
(player-games) for a particular player position. Incidence
density ratio (IDR) was also calculated to compare the
rates of AC joint injuries during passing versus rush
plays, game play compared with practice competition,
and natural surface compared with artificial surface.
7
A
95% confidence interval (CI) was calculated for each
IDR. When the IDR value is .1, the observed injury
rate is greater during ‘‘exposed’’ events (passing plays,
game play, or artificial surface); when the IDR value is
\1, the observed injury rate is greater during ‘‘unex-
posed’’ events (rush plays, practice competition, or natu-
ral surface). If the 95% CI for the IDR does not include
1, this reflects a statistically significant difference
between the 2 observed injury rates. A Pvalue of \.05
was considered significant.
RESULTS
Over 12 consecutive NFL seasons from 2000 to 2011, there
were a total of 30,304 injuries reported to the NFLISS,
with 2486 (8.2%) shoulder injuries. Of these shoulder inju-
ries, 727 (29.2%) involved the AC joint during 278,758 ath-
lete exposures. The overall rate of AC joint injuries in NFL
2Lynch et al The American Journal of Sports Medicine
football players was 26.1 per 10,000 athlete exposures. The
most common injuries were 319 unspecified AC joint
sprains (43.9%), 210 type I AC joint sprains (28.9%), 79
type II AC joint sprains (10.9%), and 40 type III AC joint
sprains (5.5%). Over the period of the study, no type IV,
V, or VI injuries were reported (Table 1).
Of those players reported to have sustained an AC joint
injury, 360 were offensive players, 268 were defensive
players, and 99 were special teams players (P\.001 for
all comparisons). The position players that most regularly
sustained the largest number of AC joint injuries were the
defensive backs (117 injuries, 16.1%), followed by wide
receivers (114 injuries, 15.7%). The total number of AC
joint injuries in defensive backs were significantly greater
than the total number of injuries in quarterbacks (P\
.001) (Table 2).
In terms of incidence, quarterbacks were most suscepti-
ble to an AC joint injury (20.9 injuries per 100 players), fol-
lowed by special teams players (20.7/100) and wide
receivers (16.5/100) (P\.001 for quarterbacks and special
teams players vs other positions) (Table 3). The calcula-
tions for special teams players were performed while con-
sidering the total number of players on the field for
special teams’ play and not just the athletes who were
only designated special teams players (punters, kickers,
and long snappers), as discussed in the Materials and
Methods section. With PER, special teams players had
the highest risk of injury with 7.6 injuries per 1000
player-games. Quarterbacks had the next highest PER of
7.4 injuries per 1000 player-games (Table 4).
A review of the NFL data from 2000 to 2011 showed that
there were 3952 games (7904 team games). Specifically,
4750 team games were played on grass (60.1%), and 3154
team games were played on an artificial surface (39.9%).
Four hundred seventy-eight AC joint injuries occurred dur-
ing plays on natural surfaces (64.7%) versus 249 AC joint
injuries occurring during plays on artificial surfaces
(33.8%) (P\.001). Eleven AC joint injuries occurred on
unknown surfaces (1.5%). The IDR for injuries occurring
on artificial surfaces was calculated to be 0.79 (95% CI,
0.67-0.92), indicating that the observed injury rate is
greater on grass than on artificial surfaces (P\.001)
(see Appendix 2, available online).
Finally, 602 AC joint injuries were sustained during
game play (81.5%), while 125 injuries occurred during
practice (18.5%) (P\.001). During game play over the
12-season study period, there were 259,666 passing plays
(54.2%) and 219,634 rush plays (45.8%). Passing plays
accounted for 199 AC joint injuries (33.1%), while running
plays made up 170 AC joint injuries (28.2%) (P= .0926).
Other/unknown plays accounted for 233 AC joint injuries
(38.7%). The IDR for injuries occurring on passing plays
was calculated to be 0.99 (95% CI, 0.80-1.20) (see Appendix
3, available online). Meanwhile, the IDR for injuries
TABLE 1
Distribution of AC Joint Injuries, 2000-2011
a
Injury
Total AC Joint and
Distal Clavicle Injuries
Clavicle AC sprain, unspecified 319
Clavicle AC sprain, type I 210
Clavicle AC sprain, type II 79
Clavicle AC contusion 66
Clavicle AC sprain, type III 40
Clavicle AC inflammation 9
Clavicle AC dislocation 3
Clavicle AC dislocation/recurrent 1
a
AC, acromioclavicular.
TABLE 2
AC Injuries by Player Position, 2000-2011
a
Position Total (N = 727)
Defensive back 117
Wide receiver 114
Special teams player 99
Defensive lineman 82
Offensive lineman 80
Linebacker 69
Running back 67
Quarterback 57
Tight end 42
a
AC, acromioclavicular.
TABLE 3
Incidence of AC Injuries by Player Position, 2000-2011
a
Player Position Incidence (per 100 Players)
Quarterback 20.9
Special teams player 20.7
Wide receiver 16.5
Tight end 12.1
Running back 11.5
Defensive back 11.0
Linebacker 9.8
Offensive lineman 9.4
Defensive lineman 8.7
a
AC, acromioclavicular.
TABLE 4
Positional Exposure Risk of AC Injuries by
Player Position, 2000-2011
a
Player Position
Positional Exposure Risk
(Injuries per 1000 Player-Games)
Special teams player 7.6
Quarterback 7.4
Wide receiver 4.1
Running back 2.7
Tight end 2.5
Defensive back 2.3
Linebacker 2.0
Offensive lineman 1.8
Defensive lineman 1.8
a
AC, acromioclavicular.
Vol. XX, No. X, XXXX AC Joint Injuries in the NFL 3
occurring during game competition was calculated to be
17.7 (95% CI, 14.7-21.5), indicating a significantly greater
rate of injury during game play compared with practice
competition (P\.001).
The overall mean time loss for these injuries was 9.8
days (range, 0-205 days). The injuries that required the
most time lost were AC joint dislocations (mean days lost,
77.7) and AC sprains, type III (mean days lost, 26.4) (Table
5). Quarterbacks (mean days lost, 17.3) and defensive backs
(mean days lost, 14.8) lost the most days to injury (Table 6).
Surgical management was performed for 13 of these AC
joint injuries (1.7%). Details of the procedures were not
available; however, the most common diagnosis requiring
surgery was a type I AC joint sprain (n = 4). The other
diagnoses that required surgery were an unspecified AC
joint sprain (n = 3), type II AC joint sprain (n = 2), type
III AC joint sprain (n = 2), and AC joint inflammation (n
= 2). Offensive linemen underwent the most surgical proce-
dures for this injury (n = 3), followed by quarterbacks, spe-
cial teams players, wide receivers, defensive backs, and
defensive linemen (all with n = 2).
DISCUSSION
Injuries frequently occur in contact sports such as American
football. Shoulder injuries are the fourth most common injury
sustained by football players,
1-3,5,6,9,12,13,16
and AC joint
injuries are the most common shoulder injury sustained by
these athletes.
8,10
We observed that injuries to the AC joint
accounted for 30% of all shoulder injuries that occurred
over 12 consecutive NFL seasons from 2000 to 2011. Previous
studies have reported that AC joint injuries account for
37.2% to 41% of all shoulder injuries in football players.
4,8,10
These injuries typically result from contact plays in which
a direct blow to the shoulder is sustained or when the player
is tackled to the ground onto his shoulder.
One possible explanation for the slightly lower rate of AC
joint injuries in the present study is changes to practice regi-
mens that have been implemented over the past decade. For
example, quarterbacks wear red jerseys during all practices
and scrimmages, and direct contact with the quarterback is
prohibited during these activities. In the senior authors’
(M.K.B., G.W.N.) experience as NFL team physicians, the
number of full contact practices and the number of 2-a-day
workouts during preseason training have also decreased con-
siderably since the initial investigation by Kelly et al,
10
thus
resulting in less opportunities for these injuries to occur.
Kelly et al
10
also reported that shoulder injuries were
overall the second most common injury sustained by quar-
terbacks, with AC joint injuries being the most common of
these shoulder injuries. Our study differs from Kelly et al
in that we evaluated players across all playing positions
and not just quarterbacks. We found that AC joint injuries
were most commonly sustained by defensive backs, fol-
lowed by wide receivers and special teams players.
TABLE 5
Days Lost to AC Joint Injuries, 2000-2011
a
Injury Mean Days Lost Median Days Lost Range of Days Lost
Clavicle AC dislocation (n = 3) 77.7 35.0 29.0-169.0
Clavicle AC sprain, type III (n = 40) 26.4 16.0 1.0-130.0
Clavicle AC inflammation (n = 9) 12.4 4.0 1.0-81.0
Clavicle AC sprain, type II (n = 79) 10.3 6.0 1.0-50.0
Clavicle AC sprain (n = 319) 9.3 4.0 1.0-163.0
Clavicle AC dislocation/recurrent (n = 1) 8.0 8.0 8.0-8.0
Clavicle AC sprain, type I (n = 210) 7.3 3.0 1.0-158.0
Clavicle AC contusion (n = 66) 6.2 3.0 0.0-57.0
All AC joint injuries (N = 727) 9.8 4.0 0.0-205.0
a
AC, acromioclavicular.
TABLE 6
Days Lost to AC Joint Injuries by Player Position, 2000-2011
a
Position Mean Days Lost Median Days Lost Range of Days Lost
Quarterback (n = 57) 17.3 9.0 1.0-145.0
Defensive back (n = 117) 14.8 4.0 0.0-169.0
Running back (n = 67) 11.0 4.0 1.0-158.0
Offensive lineman (n = 80) 10.0 4.0 1.0-117.0
Wide receiver (n = 114) 9.7 3.0 1.0-205.0
Special teams player (n = 99) 9.5 4.0 1.0-94.0
Tight end (n = 42) 8.6 7.0 1.0-30.0
Defensive lineman (n = 82) 7.7 3.0 1.0-81.0
Linebacker (n = 69) 6.9 4.0 1.0-40.0
a
AC, acromioclavicular.
4Lynch et al The American Journal of Sports Medicine
However, the incidence of these injuries was greatest in
quarterbacks, followed by special teams players and wide
receivers. In addition, the mean time lost to injury in this
study was 17.3 days for quarterbacks compared with 22
days in the study by Kelly et al. This difference may be
because the Kelly et al study defined an injury as one in
which the athlete was restricted for at least 2 days, while
our study defined an injury as one in which the athlete
left the game or practice or if the injury resulted in a loss
of at least 1 practice, game, or training session. The more
inclusive definition of injury in this study likely captured
more occurrences of shoulder injuries and may provide
a truer sense of the number and distribution of the type of
AC joint injury over the course of the football season.
Of the AC joint injuries analyzed in the current study, all
were unexpectedly type III or less according to the Rockwood
classification system. One explanation for this finding is that
severe AC joint injuries (types IV-VI) rarely occur in NFL
athletes in part because of the protective effect of shoulder
pads. Moreover, grade V injuries may have been misclassi-
fied as type III injuries because of the low interobserver
and intraobserver reliability of this classification system.
11,14
Finally, injuries classified as ‘‘clavicle AC dislocations’’ may
include higher (type IV-VI) AC joint injuries.
Interestingly, the majority of AC joint injuries included
in this study were treated nonoperatively, with only 1.7%
of these injuries requiring surgery. This is substantially
less than a prior report by Kaplan et al
8
in which 12% of
prospective NFL players underwent surgical treatment
for these injuries. However, Dragoo et al
4
reported a similar
operative rate of 2.4% for these injuries. Although the
NFLISS database lacks specific surgical information such
as the type of surgical intervention or acuity of the proce-
dure, in the experience of the senior authors, the operative
intervention for these types of injuries is typically a distal
clavicle excision for chronic symptoms.
The strengths of this study are that we investigated AC
joint injuries over 12 seasons. We also evaluated these
injuries in all NFL players during all facets of play includ-
ing all games, practices, and scrimmages, and as a result,
our data may provide a more accurate incidence of AC joint
injuries in the NFL than prior studies. Despite an increase
in player size over this time, we did not see an increase in
the number or severity of AC joint injuries.
There are several important limitations to our study.
The NFLISS is a well-established and highly regarded
reporting system, but as with any large database, there
is a possibility of inclusion of incomplete or inaccurate
information. For example, the database allows the trainer
to select ‘‘unspecified AC joint sprain.’’ This relatively
vague category was the most commonly entered diagnosis,
and it would have been preferable to have these cases clas-
sified as a more specific diagnosis. Additionally, clinical
follow-up and specific details on the surgical procedures
were not available for review. Clearly, these variables
would have allowed for better insight into how these inju-
ries are managed and how players perform after surgical
treatment. Finally, it is possible that injuries were unre-
ported or underreported by the medical team. Despite
these limitations, we were able to show that AC joint inju-
ries account for approximately one third of all shoulder
injuries in NFL players and that the vast majority of these
injuries are treated without surgery. The data in the pres-
ent study represent the most complete and current data on
AC joint injuries in NFL players.
ACKNOWLEDGMENT
The authors acknowledge the assistance of Dr Vandana
Menon, Kristina Franke, and the rest of the team with
Outcome Sciences Inc in the preparation of the NFLISS
data that were used in this article.
REFERENCES
1. Canale ST, Cantler ED Jr, Sisk TD, Freeman BL 3rd. A chronicle of
injuries of an American intercollegiate football team. Am J Sports
Med. 1981;9(6):384-389.
2. Culpepper MI, Niemann KM. High school football injuries in Birming-
ham, Alabama. South Med J. 1983;76(7):873-875, 878.
3. DeLee JC, Farney WC. Incidence of injury in Texas high school foot-
ball. Am J Sports Med. 1992;20(5):575-580.
4. Dragoo JL, Braun HJ, Bartlinski SE, Harris AH. Acromioclavicular
joint injuries in National Collegiate Athletic Association football:
data from the 2004-2005 through 2008-2009 National Collegiate Ath-
letic Association Injury Surveillance System. Am J Sports Med.
2012;40(9):2066-2071.
5. Garrahan WF. The incidence of high school football injuries. R I Med
J. 1967;50(12):833-835.
6. Hale RW, Mitchell W. Football injuries in Hawaii 1979. Hawaii Med J.
1981;40(7):180-182.
7. Hershman EB, Anderson R, Bergfeld JA, et al. An analysis of specific
lower extremity injury rates on grass and FieldTurf playing surfaces in
National Football League games: 2000-2009 seasons. Am J Sports
Med. 2012;40(10):2200-2205.
8. Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and
variance of shoulder injuries in elite collegiate football players. Am J
Sports Med. 2005;33(8):1142-1146.
9. Karpakka J. American football injuries in Finland. Br J Sports Med.
1993;27(2):135-137.
10. Kelly BT, Barnes RP, Powell JW, Warren RF. Shoulder injuries to
quarterbacks in the National Football League. Am J Sports Med.
2004;32(2):328-331.
11. Kraeutler MJ, Williams GR Jr, Cohen SB, et al. Inter- and intraobserver
reliability of the radiographic diagnosis and treatment of acromioclavicular
joint separations. Orthopedics. 2012;35(10):e1483-e1487.
12. Lackland DT, Akers P, Hirata I Jr. High school football injuries in
South Carolina: a computerized survey. J S C Med Assoc.
1982;78(2):75-78.
13. Moretz A 3rd, Rashkin A, Grana WA. Oklahoma high school football injury
study: a preliminary report. J Okla State Med Assoc. 1978;71(3):85-88.
14. Ng C, Smith EK, Funk L. Reliability of the traditional classification
system for acromioclavicular joint injuries by radiography. Shoulder
Elbow. 2012;4(4):266-269.
15. Pallis M, Cameron KL, Svoboda SJ, Owens BD. Epidemiology of
acromioclavicular joint injury in young athletes. Am J Sports Med.
2012;40(9):2072-2077.
16. Saal JA. Common American football injuries. Sports Med. 1991;
12(2):132-147.
For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav
Vol. XX, No. X, XXXX AC Joint Injuries in the NFL 5
... [66][67][68][69] In athletes such as collegiate and professional football players as well as military cadets, the incidence increases to 3.3 to 26 per 10,000 exposures. [70][71][72][73] The literature demonstrates that males sustain anywhere from 2.2 to 8.5 more AC joint separations than females. 66,72,73 Low-grade separation (Rockwood Types I and II) occur more often compared to high-grade separations (Rockwood Types III and higher), ranging from 4-11%. ...
... 66,72,73 Low-grade separation (Rockwood Types I and II) occur more often compared to high-grade separations (Rockwood Types III and higher), ranging from 4-11%. [70][71][72] LITERATURE ASSESSMENT (NONOPERATIVE ...
Article
Full-text available
Traumatic injuries of the acromioclavicular joint result in pain and potentially long-term alterations in scapulohumeral rhythm that occurs due to disruption of the clavicular strut function which is integral to scapular kinematics. Nonoperative treatment remains a valid option in most acromioclavicular joint injuries with the potential of minimizing pain and restoring scapulohumeral rhythm. However, few studies have provided nonoperative treatment details. Therefore, the purpose of this clinical commentary is to discuss the rationale, indications, and techniques of nonoperative treatment and present an organized approach for evaluating and managing such patients based on the best available evidence. Attention will be focused on identifying the treatment methods employed and the results/outcomes of such treatments. Level of evidence: 5.
... Although there is a large volume of research on specific injuries such as concussions, Anterior Cruciate Ligament injuries, and hamstring strains, we do not have the same understanding of general risk factors contributing to the overall spectrum of NFL injuries (1,2,9,11). One factor associated with increased injury risk is play type (running vs. passing), with previous studies having shown that concussions, hamstring strains, Acromioclavicular joint injuries, and shoulder injuries are more likely to occur during passing plays (2,6,(9)(10)(11). Conversely, fractures of the distal fibula are more likely to occur on running plays (16). ...
... Given our study's findings, the authors of future studies should examine the direct effects of rule changes on in-game injury risks. This is the first study to the best of our knowledge to examine overall in-game injury rates by play type because past studies have limited analyses to specific injuries or player types (2,6,9,10). ...
Article
Full-text available
Burke, J, Geller, JS, Perez, JR, Naik, K, Vidal, AF, Baraga, MG, and Kaplan, LD. The effect of passing plays on injury rates in the national football league. J Strength Cond Res 35(12S): S1-S4, 2021-The National Football League (NFL) has one of the highest all-cause injury rates in sports, yet our understanding of extrinsic injury risk factors is limited. The objective of this study was to assess the effect of play type on injury incidence in the NFL. We obtained data for every regular season game played during the 2013-2016 seasons from the official NFL game books. There were 2,721 in-game injuries during the 4 seasons examined, with an overall rate of 1.33 injuries per team per game. For statistical analysis, p < 0.05 was considered significant. Passing plays conferred significantly higher odds of injury than running plays (odds ratio [OR] 1.4, 95% confidence interval [CI]: 1.3-1.5, p < 0.0001). This primarily stems from increased risks in quarterbacks (OR 6.9, 95% CI: 3.6-13.3, p < 0.0001), receivers (OR 5.0, 95% CI: 3.7-6.6, p < 0.0001), and defensive backs (OR 2.3, 95% CI: 1.9-2.7, p < 0.0001). Our study suggests that passing plays confer a greater risk of overall injuries in the NFL when compared with running plays, specifically regarding concussions and core or trunk injuries.
... Our return-to-sport time frame is much shorter compared with previously published post-ACJ surgery data in collision athletes. 20,21,36 The only previously published study of post-ACJ surgical outcomes in AFL players reported an average return-to-sport-specific training and return to competitive matches at 13.6 and 18.8 weeks, respectively. 7 Marcheggiani Muccioli et al 21 compared the outcomes of professional and nonprofessional athletes after open ACJ reconstruction with a Ligament Augmentation and Reconstruction System (LARS) ligament. ...
Article
Full-text available
Background Acromioclavicular joint (ACJ) injuries are the second most common upper limb injuries in the Australian Football League (AFL); however, there is little evidence on the return-to-sport results after surgical stabilization of the ACJ in this sporting population. Purpose To investigate the return-to-sport time, on-field performance, and patient-reported outcomes in a series of professional AFL players after undergoing ACJ stabilization. Study Design Case series; Level of evidence, 4. Methods We conducted a retrospective case series of all AFL players who had undergone open twin-tailed dog-bone ACJ stabilization by a single surgeon between September 2013 and April 2017. Outcome measures included time to return to sport, on-field performance indicators (handballs, tackles, kicks, and AFL Fantasy and Supercoach scores), the Nottingham Clavicle Score, Oxford Shoulder Score, and the Specific Acromioclavicular Score. Patient-reported outcomes were evaluated at a minimum follow-up of 12 months. Results Of 13 senior listed AFL players who underwent twin-tailed dog-bone surgery, 9 players were included. Mean follow-up was 24.8 months (range, 5-41 months) postoperatively. Mean return-to-sport time was 8.6 weeks for injuries that occurred within the season. The number of kicks, marks, handballs, and tackles as well as AFL Supercoach and Fantasy scores did not significantly change after surgery ( P > .05). Outcome measures showed a high level of patient satisfaction after surgery, with a mean Nottingham Clavicle Score of 92.2, Oxford Shoulder Score of 47.7, and the Specific Acromioclavicular Score of 7.5. Conclusion In a collective of professional AFL players with ACJ injury, our twin-tailed dog-bone technique revealed return to competitive play could be achieved at a mean of 8.6 weeks without compromising on-field performance or patient-reported pain, function, and satisfaction.
... Research has been conducted to study injuries in the NFL ranging from concussions to acromioclavicular joint injuries to anterior cruciate ligament injuries (4,18,22). Injuries such as these can cause players to sit out of games. However, research has yet to be conducted on how these injuries to players impact a NFL team's success. ...
Article
Full-text available
An expert strength and conditioning coach can be an important component of a sports performance and medicine staff that will train their athletes to help them become more resilient to injury. Previous research in a variety of sports has shown that teams with players that have fewer games missed due to injury have achieved greater success. The purpose of this study was to determine if a relationship exists between games missed due to injury by offensive and defensive starters on National Football League (NFL) rosters and a NFL team's ability to win during the 2010-19 NFL seasons. A Spearman rank-order correlation analysis set at (p ≤ 0.01) level of significance indicated that fewer games missed by starters in the NFL is correlated with multiple variables associated with winning such as games won per season and playoff appearances. These results were obtained after analyzing all 32 NFL teams from the 2010-19 seasons. Descriptive statistics were also used to further analyze the data set and found that teams ranked in the top-five in terms of fewest injuries outperformed the remainder of the teams in the NFL according to multiple variables associated with winning. The data in this study supports that NFL organizations that have fewer games missed due to injury of their athletes may have a better opportunity of achieving success.
... Acromioclavicular joint injuries are a common problem that accounts for more than 12% of shoulder injuries [1,2]. The spectrum of acromioclavicular joint injuries can range from a simple strain with very mild consequences to severe dislocations and rupture of the fascia, rupture of the coracoclavicular ligament, and consequently severe shoulder dysfunction [3,4]. The goal of dislocation treatment is to return the patient to pre-injury activity with a goal of power, painless, and mobile shoulder joint. ...
Article
Background: Based on different treatment outcomes and different treatment methods for acromioclavicular dislocation, we decided to evaluate the treatment outcomes of acromioclavicular joint dislocation using tightrope arthroscopy. Methods: This retrospective cross-sectional study was performed on patients with acromioclavicular joint dislocation referred to Alzahra Hospital in Isfahan and Abadan-Iran from 2015 to 2017. Information that was assessed included age, sex, type of dislocation (Figure 1), duration of injury, cause of injury, complications such as osteoarthritis, changes in the distance between the joints, as well as the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were collected after 6 months of surgery. Results: There was a significant relationship between horizontal change instability and type of injury that 9 cases (60%) of type 5 of injury and 0 of type 3 had horizontal change instability (P=0.01). There was a reverse significant correlation between ASES score and duration of injury (r=-0.58, P=0.01). Conclusion: Acromioclavicular joint dislocations could successfully be treated with the TightRope system. We also showed that patient's pain and functions are diversely correlated with injury durations.
Article
BACKGROUND: American Football (AF) players are assigned to positions by specific abilities and responsible for different tasks on the field what may result in wide differentiation in experienced injuries. The aim of this study was to analyze the causes of injuries and their differentiation depending on the position on the pitch. METHODS: Original questionnaire was used to investigate 150 Polish amateur AF players who had suffered from 189 injuries. The questionnaire detailed the following positions: offensive line (OL), defensive line (DL), quarterback (QB), running back (RB), wide receiver (WR), linebacker (LB), defensive backs (DB). The results were statistically analyzed by SofaStas v. 1.4.5 and then had been interpreted. RESULTS: Over 90% of all investigated AF players had self-reported injury history with the injury rate 1.27 injury per player. No statistically significant relationship was stated between position on the pitch and the occurrence rate, type and location of the injury. Significant relationship (p=0.030) was stated between the injury circumstances and position on the pitch - QB were mostly injured in collision with opponent, OL in direct sport fight while WR and RB due to a falls. CONCLUSIONS: Occurrence and type of injuries in AF players does not depend on position on the pitch in AF. Relationship between the injury location or injury circumstances and position on the pitch requires further studies. The most common location of injury is the knee joint and the most common type of injury is sprain while the most common causes of injury were collision with opponent and direct sport fight.
Article
Full-text available
Background Acromioclavicular joint (ACJ) separation injuries are uncommon in professional soccer players, threatening future performance and team contributions. Data regarding return to play (RTP) in professional soccer players after ACJ separation are limited. Purpose To determine the rate, time to RTP, and player performance after ACJ separation in soccer players from the top 5 professional European leagues when compared with a retrospective, matched cohort of uninjured players. Study Design Cohort study; Level of evidence, 3. Methods Professional soccer players suffering ACJ separation injuries between 1999 and 2018 were identified and were matched to uninjured players (2 controls to 1 injured player) by position, height, age, season year, and length of time played. Information on date of injury, timing to RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) were collected from transfermarkt.co.uk, uefa.com , fifa.com , official team websites, public injury reports, and press releases. Change in performance metrics for the 4 seasons after the season of injury were based on metrics 1 season before injury. Univariate comparisons were performed using independent 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results A total 59 soccer players with ACJ separation injuries were identified. Mean age at injury was 24.6 ± 5.3 years. Of these, 81% of the players returned to play, with 69% returning within postinjury season 1. Mean time to RTP was 49.8 ± 24.3 days (5.9 ± 4.1 games). Two players suffered recurrent ACJ separation injuries in their professional soccer careers. There were no significant differences between athletes who sustained ACJ injuries versus control athletes in the number of games played, minutes per game per season, goals scored, assists, or points in the 4 seasons after injury. Defenders played fewer minutes and recorded fewer assists during postinjury season 1 when compared with control athletes. Conclusion Of the 59 elite soccer players who sustained ACJ separation injuries during the study period, 81% returned to elite competition. Performance metrics were similar to preinjury levels and matched, uninjured control players.
Chapter
American football is one of the most popular sports in the United States and is a high-speed, high-impact collision sport. Athletes are susceptible to various injuries ranging from muscle strains to career-ending fractures and ligamentous injuries. Common injuries sustained in American football include concussions, anterior cruciate ligament and medial collateral ligament tears, glenohumeral shoulder instability, acromioclavicular joint injuries and clavicle fractures, and ankle sprains and syndesmotic injuries. Concussions can have severe physical and mental sequela, and the key to prevention of concussions is recognition of symptoms, timely treatment, and knowledge of RTP guidelines. The majority of extremity injuries cannot be avoided, but can be limited with proper physical and mental training.
Chapter
Shoulder and elbow injuries are extremely prevalent in football. Common shoulder injuries include shoulder instability/labral tears, acromioclavicular sprains/separations, rotator cuff injuries, pectoralis major injuries, and fractures. Common elbow injuries include dislocations and ulnar collateral ligament sprains. Many injuries can be managed during the season, with possible off-season surgery if needed. This chapter describes the evidence available for managing these injuries during the season, as well as describes some methods and recommendations to assist in management.
Article
Full-text available
The management of acromioclavicular joint separations, in particular Rockwood types III and V, remains controversial. The purpose of this study was to investigate the observer reliability of shoulder surgeons when presented with the same cases of acromioclavicular joint separations. The authors retrospectively identified 28 patients who were diagnosed with a type III, IV, or V acromioclavicular joint separation. A PowerPoint presentation was compiled that contained an anteroposterior and axial radiograph from each patient prior to treatment. Radiographs were sent to surgeons, who diagnosed each injury according to the Rockwood classification and stated whether they recommended operative or nonoperative treatment for each patient.Inter- and intraobserver reliability were calculated from the surgeons' reviews. Repeat diagnoses were returned by 8 surgeons. A single-measure intraclass correlation coefficient (ICC) was used to determine interobserver reliability for the surgeons' Rockwood classifications (ICC=0.602) and their decision to operate (ICC=0.469). Intraobserver reliability also was calculated for Rockwood classifications (ρ=0.694) and decision to operate (κ=0.366). Two (25%) of 8 surgeons stated that they would have used open and arthroscopic techniques for repairing the dislocations, whereas the remaining (75%) surgeons would have performed open techniques. Individual surgeons were consistent in their grading of acromioclavicular joint dislocations, but less observer agreement existed among the surgeons. Poor agreement among surgeons for the decision to operate indicates that this decision is heavily influenced by clinical factors and the radiographic classification.
Article
Full-text available
Injuries to the shoulder are common in collegiate football, and injuries to the acromioclavicular (AC) joint have previously accounted for up to 41% of all shoulder injuries. To determine the incidence and epidemiology of injury to the AC joint in National Collegiate Athletic Association (NCAA) football athletes. Descriptive epidemiology study. The NCAA Injury Surveillance System (ISS) men's football database was reviewed from the 2004-2009 playing seasons. The exposure data set from the same years was reviewed for the purposes of computing rates of injury per athlete exposure (AE). The injury rate (number of injuries divided by number of AEs) was computed per 10,000 AEs for competition and practice exposures. Ninety-five percent confidence intervals (95% CIs) for the incidence rates were calculated using assumptions of a Poisson distribution. According to the estimates made by the NCAA ISS, a total of 748 injuries to the AC joint occurred in NCAA football players during 2,222,155 AEs, accounting for 4.49% of all injuries sustained during this 5-year surveillance period. The overall rate of injury was 3.34 per 10,000 AEs (95% CI, 3.10-3.59). Players were 11.68 (95% CI, 10.11-13.49) times more likely to sustain an injury in games than practices. Partial sprains (types I or II) accounted for 96.4% of injuries, while complete sprains (≥type III) accounted for the remaining 3.6%. The average amount of time lost per injury was 11.61 days. Complete sprains resulted in a mean time loss of 31.9 days (95% CI, 24.4-39.6) while partial injuries resulted in 11.0 days lost (95% CI, 9.6-12.3). Overall, 2.41% of injuries underwent surgical intervention, with 22.2% of complete sprains and 1.7% of partial injuries resulting in surgery. Complete sprains of the AC joint were 13.5 (95% CI, 4.63-35.26) times more likely to result in surgical intervention than partial sprains. The majority of injuries (71.93%) resulted from contact with another player and 47.09% occurred while tackling or being tackled. Of all injuries, 47.63% occurred during offensive plays, while defense accounted for 20.77%. AC joint injuries in NCAA football players are predominantly low-grade sprains, leading to approximately 12 days of lost competition. The few severe sprains that occurred often resulted in surgery or required approximately 5 weeks of rehabilitation.
Article
Background Quarterbacks are at risk for shoulder injury secondary to both the throwing motion as well as from contact injury. Objective To delineate the incidence and etiology of shoulder injuries to quarterbacks in the National Football League (NFL). Methods Using the NFL Injury Surveillance System (NFLISS), all reported injuries to quarterbacks between 1980 and 2001 were identified. Results A total of 1534 quarterback injuries were identified with a mean of 18.8 and a median of 6.0 days of playing time lost. The majority of these injuries occurred during a game (83.8%). Passing plays were responsible for 77.4% of all quarterbackrelated injuries. Shoulder injuries were the second most common injury reported (233 or 15.2%), following closely behind head injuries (15.4%). Direct trauma was responsible for 82.3% of the injuries, with acromioclavicular joint sprains being the most common injury overall (40%). Overuse injuries were responsible for 14% of the injuries, the most common being rotator cuff tendinitis (6.1%) followed by biceps tendinitis (3.5%). Conclusion In this review, the vast majority of shoulder injuries in quarterbacks occurred as a result of direct trauma (82.3%), and less than 15% were overuse injuries resulting from the actual throwing motion.
Article
Background The present study aimed to examine the reliability of the radiographic classification systems for acromioclavicular (AC) joint injuries. Methods We initially polled 47 orthopaedic surgeons regarding what common technique they used for applying the Rockwood and the Tossy and Allman classification systems. All used a single standard AC joint view (Zanca view). We then presented 24 Zanca view radiographs of patients who had sustained AC joint injuries to 19 specialist shoulder surgeons and asked each of them to classify the injuries using the Rockwood and the Tossy and Allman classification systems. We then altered the order of radiographs and repeated the survey with the same group of surgeons 1 month later. Results The mean inter-observer agreement and the corresponding weighted kappa for the Rockwood and the Tossy and Allman classification system were 64.6% and 0.258; and 68.1% and 0.309, respectively. The mean intra-observer agreement and the corresponding weighted kappa for the systems were 59.4% and 0.150; and 67.4% and 0.113, respectively. Conclusions We conclude that the classification of AC joint injuries using a radiograph alone has limited reliability and consistency in clinical practice.
Article
Background: Players in the National Football League (NFL) sustain injuries every season as the result of their participation. One factor associated with the rate of injury is the type of playing surface on which the players participate. Hypothesis: There is no difference in the rate of knee sprains and ankle sprains during NFL games when comparing rates of those injuries during games played on natural grass surfaces with rates of those injuries during games played on the artificial surface FieldTurf. Study design: Descriptive epidemiology study. Methods: The NFL records injury and exposure (ie, game) data as part of its injury surveillance system. During the 2000-2009 NFL seasons, there were 2680 games (5360 team games) played on grass or artificial surfaces. Specifically, 1356 team games were played on FieldTurf and 4004 team games were played on grass. We examined the 2000-2009 game-related injury data from those games as recorded by the injury surveillance system. The data included the injury diagnosis, the date of injury, and the surface at the time of injury. The injury data showed that 1528 knee sprains and 1503 ankle sprains occurred during those games. We calculated injury rates for knee sprains and ankle sprains-specifically, medial collateral ligament (MCL) sprains, anterior cruciate ligament (ACL) sprains, eversion ankle sprains, and inversion ankle sprains-using incidence density ratios (IDRs). We used a Poisson model and logistic regression odds ratios to validate the IDR analysis. A multivariate logistic regression model was used to adjust the odds ratio for weather conditions. Results: The observed injury rate of knee sprains on FieldTurf was 22% (IDR = 1.22, 95% confidence interval [CI], 1.09-1.36) higher than on grass, and the injury rate of ankle sprains on FieldTurf was 22% (IDR = 1.22, 95% CI, 1.09-1.36) higher than on grass. These differences are statistically significant. Specifically, the observed injury rates of ACL sprains and eversion ankle sprains on FieldTurf surfaces were 67% (P < .001) and 31% (P < .001) higher than on grass surfaces and were statistically significant. The observed injury rates of MCL sprains and inversion ankle sprains were also not significantly higher on FieldTurf surfaces (P = .689 and .390, respectively). Conclusion: Injury rates for ACL sprains and eversion ankle sprains for NFL games played on FieldTurf were higher than rates for those injuries in games played on grass, and the differences were statistically significant.
Article
Acromioclavicular (AC) joint injuries, particularly sprains, are common in athletic populations and may result in significant time lost to injury. However, surprisingly, little is known of the epidemiology of this injury. To define the incidence of AC joint injuries and to determine the risk factors for injury. Descriptive epidemiological study. A longitudinal cohort study was performed to determine the incidence and characteristics of AC joint injury at the United States Military Academy between 2005 and 2009. All suspected AC joint injuries were reviewed by an independent orthopaedic surgeon using both chart reviews as well as assessments of radiological imaging studies. Injuries were graded according to the modified Rockwood classification system as well as dichotomized into low-grade (Rockwood types I and II) and high-grade (Rockwood types III, IV, V, and VI) injuries for analysis. Injury mechanisms, return-to-play timing, and athlete-exposures were documented and analyzed. χ(2) and Poisson regression analyses were performed, with statistical significance set at P < .05. During the study period, 162 new AC joint injuries and 17,606 person-years at risk were documented, for an overall incidence rate of 9.2 per 1000 person-years. The majority of the AC joint injuries were low-grade (145 sprains, 89%) injuries, with 17 high-grade injuries. Overall, male patients experienced a significantly higher incidence rate for AC joint injuries than female patients (incidence rate ratio [IRR], 2.18; 95% confidence interval [CI], 1.21-4.31). An AC joint injury occurred most commonly during athletics (91%). The incidence rate of AC joint injury was significantly higher in intercollegiate athletes than intramural athletics when using athlete-exposure as a measure of person-time at risk (IRR, 2.11; 95% CI, 1.31-3.56). Similarly, the incidence rate of AC injury was significantly higher among male intercollegiate athletes when compared to female athletes (IRR, 3.56; 95% CI, 1.74-8.49) when using athlete-exposure as the denominator. The intercollegiate sports of men's rugby, wrestling, and hockey had the highest incidence rate of AC joint injury. Acromioclavicular injuries resulted in at least 1359 total days lost to injury and an average of 18.4 days lost per athlete. The average time lost to injury for low-grade sprains was 10.4 days compared with high-grade injuries at 63.7 days. Of the patients with high-grade injuries, 71% elected to undergo coracoclavicular/AC reconstructions. The rate of surgical intervention was 19 times higher for high-grade AC joint injuries than for low-grade injuries (IRR, 19.2; 95% CI, 7.64-48.23; P < .0001). Acromioclavicular separations are relatively common in young athletes. Most injuries occur during contact sports such as rugby, wrestling, and hockey. Male athletes are at greater risk than female athletes. Intercollegiate athletes are at greater risk than intramural athletes. The average time lost to sport due to AC joint injury was 18 days, with low-grade injuries averaging 10 days lost. High-grade injuries averaged 64 days lost to sport, and 71% elected to undergo surgical repair/reconstruction.
Article
This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diag nosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed cal culation of the time of exposure to injury per athlete in the sample. There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an inci dence of injury of 0.506 injury per athlete per year. Severe injuries—those requiring hospitalization—were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.
Article
As many as 1.5 million young men participate in American football in the United States. An estimated 1.2 million football-related injuries are sustained annually. Since the 1970s epidemiological studies have shown that the risk of injury is higher in older athletes and lower in teams with more experienced coaches and more assistant coaches. 51% of injuries occurred at training; contact sessions were 4.7 times more likely to produce injuries than controlled sessions. Injury rates were reduced by wearing shorter cleats and preseason conditioning. Overall, lower extremity injuries accounted for 50% of all injuries (with knee injuries accounting for up to 36%). Upper extremity injuries accounted for 30%. In general, sprains and strains account for 40% of injuries, contusions 25%, fractures 10%, concussions 5% and dislocations 15%. Cervical spine injuries have the potential to be catastrophic, but they declined dramatically in the decade 1975 to 1984, due to the impact of rule changes modifying tackling and blocking techniques and improved fitness, equipment and coaching. Appropriate diagnostic evaluation of cervical injuries is mandatory. The evidence supporting prophylactic knee bracing is not compelling and does not mandate compulsory or routine use. Return to play criteria include: full range of motion; normal strength; normal neurological evaluation; no joint swelling or instability; ability to run and sustain contact without pain; no intake of pain medication; player education about preventive measures and future risks. These criteria should be strictly observed. In addition to ankle and knee rehabilitation, lumbar spine injuries present a challenge for the physician. Repetitive flexion, extension and torsional stresses predispose the lumbar spine to injury. Rehabilitation consists of pain control and training. The training phase aims to eliminate repetitive injuries by minimising stress at the intervertebral joint. Football is a high risk sport. Coaches, players, trainers and physicians must all become aware of the proper means to prevent injuries.