TABLE 1.
Summary of Injury-Specific NFL Combine Level 3 Retrospective Studiesa
| First Author | Injury/Surgery | Years | Injuries (Athletes), n | Methods | Results |
|---|---|---|---|---|---|
| Cervical spine | |||||
| Schroeder35 | Cervical spine diagnosis | 2003-2011 | 143 (143) | Study on athletes with a history of a cervical spine diagnosis Control group matched by age, position, year drafted, and round drafted Outcomes: draft status, years played, games played and started, performance |
Most common diagnoses: spondylosis, stenosis, cervical sprain/strain Athletes with cervical spine diagnosis were less likely to be drafted vs controls (P = .001) Athletes drafted who had a cervical spine diagnosis had decreased total games played (P = .01) but no significant differences in number of games started or performance score vs controls Athletes with cervical spine stenosis and those with prior cervical spine surgery demonstrated no difference in performance-based outcomes and no reports of neurological injury during their careers |
| Presciutti30 | Chronic stinger syndrome | 2005-2006 | 28 (28) | Study on athletes with cervical spine MRI Athletes with chronic stingers vs those without chronic stingers and age-matched nonathletes Outcomes: mean subaxial cervical space available for the cord (MSCSAC), mean subaxial cervical Torg ratio |
Athletes with chronic stingers had lower MSCSAC (4.5) vs those without chronic stingers (5.8; P < .01) and controls (6.7; P < .001) A critical value of 5.0 mm for the MSCSAC produced a sensitivity of 80% and a negative likelihood ratio of 0.23 for predicting chronic stingers MSCSAC more accurate than the classic Torg ratio |
| Foot | |||||
| Carreira7 | Jones fracture/fifth metatarsal diaphyseal stress fracture | 2004-2009 | 74 (68) | Study on athletes with a history of a Jones or proximal diaphyseal fifth metatarsal fracture Control group matched by draft status, player position, BMI, and medical grade Outcomes: games played and started, years played |
Among all fractures, 61% were Jones, 20% were proximal diaphyseal, and 19% were of indeterminate location No significant differences in mean games played/started, total years, and likelihood of being drafted between fracture and control groups |
| Tu37 | Jones fracture fixation | 2012-2015 | 41 (40) | Study on athletes who had undergone fixation of Jones fracture Control group with no history of Jones fracture fixation Outcomes: draft status, games played and started |
All fractures treated with intramedullary screw fixation with 92% complete union No athletes, including those with incomplete union, had any limitations in strength of ROM No significant differences between percentage drafted, games played, or games started between fracture and control groups |
| McHale25 | Lisfranc injury | 2009-2015 | 41 (41) | Study on athletes with a history of a Lisfranc injury Control group with no history of midfoot injury matched by position Outcomes: draft status and position, games played and started, NFL career length ≥2 y |
63% of injuries treated operatively Athletes treated surgically were more likely to go undrafted (P = .04) and had a worse draft position (P = .03) vs those treated nonoperatively Athletes with Lisfranc injury had worse draft position (P = .04) and fewer games played (P = .001) and started (P = .08) vs controls Athletes with >2-mm residual displacement on radiograph had worse outcomes across all measurements vs those with ≤2-mm displacement |
| Vopat38 | Navicular injury | 2009-2015 | 15 (14) | Study on athletes with a history of a navicular injury Control group matched by position and composed of players who missed <2 games in college and did not undergo previous surgery or have a documented injury Outcomes: draft status and position, games played and started, NFL career length ≥2 y |
11 overt navicular fractures, 3 stress reactions on MRI 8 athletes with navicular fracture underwent surgery Evidence of ipsilateral talonavicular arthritis in 75% of those with fracture vs 60% in the uninjured foot (P = .04) 57% of athletes with navicular injury were undrafted vs 31% of the control group (P = .001) 29% of athletes with navicular injury played ≥2 y vs 70% of the control group (P = .02) |
| Hip/groin | |||||
| Knapik14 | Athletic pubalgia repair | 2012-2015 | 55 (55) | Study on athletes who had undergone surgical repair for athletic pubalgia Control group without history of athletic pubalgia repair Outcomes: draft status, current NFL status, games played and started, positive pathology (pubic plate injury, rectus abdominis injury, adductor aponeurosis injury, or combination thereof) on postsurgical MRI |
No significant differences in games played/started, draft status, or current status between athletic pubalgia and control groups 53% of those with postsurgical MRI showed positive pelvic pathology No significant differences in games played/started, draft status, and current status between athletes with negative and positive MRI pathologies Offensive linemen (P = .005) and athletes who had surgery <1 y before NFL Combine (P = .03) were more likely to have positive pathology on MRI |
| Knapik17 | Hip arthroscopic surgery | 2012-2015 | 15 (14) | Study on athletes who had undergone hip arthroscopic surgery Control group with no history of hip arthroscopic surgery Outcomes: draft status, games played and started, current status |
Acetabular labral tearing was treated with repair alone (73%), debridement alone (7%), or repair and debridement (13%) in 93% of hips undergoing arthroscopic surgery Decompression for FAI was performed in 33% of hips No significant differences in draft status, current status, games played, or games started between surgical and control groups |
| Knee | |||||
| Keller13 | ACLR | 2010-2014 | NA (98) | Study on athletes with a history of ACLR Control group matched by age, size, and position Outcomes: 40-yd dash, vertical leap, broad jump, shuttle drill, 3-cone drill |
No significant differences in 40-yd dash times, vertical leap, broad jump, shuttle drill times, and 3-cone drill times between ACLR and control groups |
| Provencher31 | ACLR | 2009-2015 | NA (110) | Study on athletes with a history of ACLR Injury-free control group matched by position and draft class Outcomes: draft status, games played and started, snap percentage |
Athletes with prior ACLR were drafted lower (P = .019), played and started fewer games (P ≤ .003), and had lower snap percentage (P < .001) Defensive linemen, defensive backs, and linebackers were most affected positions |
| Provencher32 | Chondral injury | 2009-2015 | 124 (101) | Study on athletes with knee chondral injuries without history of prior knee surgery Injury-free drafted control group Outcomes: draft position, games played and started, snap percentage, position-specific performance metrics |
Patella (63%) and trochlea (34%) were most commonly affected Defensive linemen at highest risk for unrecognized injuries (P = .015) Athletes with untreated chondral injuries had lower draft position, played fewer games, and started fewer games than controls (P < .001) Subchondral bone edema and full-thickness cartilage injuries were associated with fewer games played (P = .003) |
| Chahla8 | Meniscectomy and chondral injury | 2009-2015 | 249 (247) | Study on athletes with chondral injury in the setting of prior meniscectomy Compared with injury-free control group matched by position Condition of the meniscus graded with modified ISAKOS scores Condition of the cartilage graded with ICRS scores Outcomes: draft position, games played and started, snap percentage |
287 players had a prior meniscectomy (206 lateral, 81 medial) Poorer meniscal score was associated with worse chondral pathology, especially in the lateral compartment Controls had greater number of games played and started and higher snap percentage vs those with prior meniscectomy of at least 10% volume Athletes with severe chondral lesions (ICRS grade 4) had significantly worse performance metrics vs controls |
| Logan22 | MCL injury | 2009-2015 | 337 (301) | Study on athletes with a history of MCL injury Injury-free control group Outcomes: draft position, games played and started, snap percentage |
55% had additional soft tissue injury (eg, meniscus, ACL, PCL) No significant differences in draft status/position, games played, or games started between athletes with MCL injury and controls Athletes with isolated MCL injury had better draft position (P = .034), proportion playing ≥2 NFL seasons (P = .022), games played (P = .014), and games started (P = .020) vs athletes with combined injuries |
| Chahla9 | Posterolateral corner injury | 2009-2015 | 23 (23) | Study on athletes with a history of posterolateral corner injury Inclusion criteria: positive clinical findings or previous surgery consistent with a posterolateral corner injury Compared with surgery-free control group matched by position Outcomes: varus stress physical examination, draft status, games played and started |
70% of injuries treated surgically, 30% were diagnosed on clinical examination 57% were combined injuries (with ACL, MCL, or PCL), all treated surgically 87% of injuries treated surgically were stable on examination, whereas none of the injuries managed nonoperatively were stable No significant differences in draft status, games played, or games started between posterolateral corner injury and control groups; athletes with surgically managed posterolateral corner injuries started fewer games than controls (P = .03) |
| Lumbar spine | |||||
| Moorman27 | Hyperconcavity of the lumbar vertebral end plates | 1992-1993 | 88 (88) | Study on linemen with radiographic evidence of hyperconcavity of lumbar vertebral end plates Control group of nonathletes matched by age Outcomes: incidence, association with lumbosacral spine symptoms |
Hyperconcavity present in 33% of linemen vs 8% in controls (P < .0001) Trend toward lower incidence of lumbosacral spine symptoms for those with hyperconcavity (P = .1839) When hyperconcavity was present, all 5 lumbosacral disk spaces were commonly affected |
| Paxton29 | Hyperconcavity of the lumbar vertebral end plates | 1992-1993 | 93 (93) | Study on linemen with radiographic evidence of hyperconcavity of the lumbar vertebral end plates Control group matched by year and round drafted, surgery and injury history Outcomes: percentage who played at least 1 NFL game, career length, games played and started |
No difference in likelihood of playing in NFL, years played, games played, or games started between athletes with lumbar spine hyperconcavity and controls No association between lumbar spine hyperconcavity and BMI |
| Schroeder34 | Lumbar spine diagnosis | 2003-2011 | 414 (414) | Study on athletes with a history of a lumbar spine diagnosis Control group matched by age, position, year and round drafted Outcomes: draft status, years played, games played and started, performance |
Most common diagnoses: degenerative spondylosis, herniated disc, spondylolysis with/without spondylolisthesis, strain Athletes without lumbar spine diagnosis were more likely to be drafted than those with a diagnosis (P < .001) Drafted athletes with preexisting lumbar spine injuries had decreased number of years played (P = .001), games played (P = .0001), and games started (P = .02) but not performance score (P = .013) vs controls Spondylolysis was associated with decreased career longevity (P < .05) |
| Shoulder | |||||
| Knapik16 | Bristow/Latarjet procedure | 2012-2015 | 10 (10) | Study on athletes who had undergone Bristow or Latarjet surgery Control group with history of isolated shoulder soft tissue repair without bony augmentation or fracture fixation Outcomes: draft status, games played and started, status after the athletes’ first NFL season |
70% had deficits in shoulder motion; 40% had evidence of mild glenohumeral arthritis 40% of athletes were drafted into NFL No significant risk of diminished participation with regard to games played and started vs controls 60% remained on active NFL roster after their first season |
| Knapik15 | Labral repair | 2012-2015 | 146 (132) | Study on athletes with a history of labral repair and MRI of the operative shoulder Control group with no history of labral repair Outcomes: association between primary labral repair location and presence and location of recurrent tearing, concomitant shoulder pathology, arthritis, draft status, games played and started |
32% of shoulders had recurrent labral tears on MRI Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001) Recurrent labral tearing was more common in posterior labrum in the setting of prior posterior labral repair (P = .032) No significant differences in games played and games started between athletes who had undergone labral repair and controls No significant differences in chance of being drafted, games played, and games started between athletes with recurrent tearing and intact repairs |
| Murphy28 | Anterior labral injury | 2009-2015 | 226 (206) | Study on athletes with a history of an anterior labral injury Control group without history of surgery and >2 games missed in college Outcomes: draft status, games played and started, snap percentage |
72% had surgical intervention, 38% were treated nonoperatively No significant differences in draft status, games played, games started, or snap percentage vs controls Concomitant injury (eg, SLAP tear, glenoid bone loss, Hill-Sachs lesion) was associated with lower draft position (P = .003) |
| Gibbs11 | Rotator cuff tear | 2003-2011 | NA (49) | Study on athletes with a history of a rotator cuff tear Control group matched by age, position, year and round drafted Outcomes: draft status, years played, games played and started, performance score |
45% underwent surgical intervention, 55% treated nonoperatively Athletes with rotator cuff tear were less likely to be drafted vs controls (P = .002) Athletes who were drafted started fewer games (P = .02) and played fewer years (P = .04) and fewer games (P = .04) vs controls |
| Chambers10 | SLAP tears | 2003-2011 | NA (25) | Study on athletes reporting a history of a SLAP tear Control group with no documented shoulder pathology matched by position, age, and draft year and round Outcomes: draft success, games played and started |
SLAP repairs most performed in offensive linemen (32%) Drafted athletes with SLAP tears played fewer games (P = .049) and had fewer game starts (P = .036) vs controls |
aACL, anterior cruciate ligament; ACLR, ACL reconstruction; BMI, body mass index; FAI, femoroacetabular impingement; ICRS, International Cartilage Repair Society; ISAKOS, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; MCL, medial collateral ligament; MRI, magnetic resonance imaging; NA, not available; NFL, National Football League; PCL, posterior cruciate ligament; ROM, range of motion; SLAP, superior labrum anterior-posterior.