Background: Traumatic ankle injuries are commonly complicated by persistent symptoms and the development of chronic ankle instability. Purpose: To describe the epidemiology of ankle injuries in the National Football League (NFL) and investigate the effects that ankle injuries have on performance metrics in the years after injury. Study Design: Descriptive epidemiologic study. Methods: Ankle injuries sustained by NFL players during the 2015-2016, 2016-2017, and 2017-2018 seasons were identified using the Pro Football Reference database. Cumulative incidence was calculated, and demographic identifiers were collected for each injury. The return-to-play (RTP) rate was also recorded. For each player who met inclusion for the performance analysis, power rating (PR) was calculated for the preinjury season (Y–1) and 2 postinjury seasons (Y+1 and Y+2) as follows: PR = ( offensive yards/10) + ( total touchdowns × 6) + ( combined tackles) + ( sacks × 2) + ( interceptions × 2). Mean PRs were calculated for each season as well as the percentage change and mean difference in PR between Y–1 and Y+1 (ΔPR1%, ΔPR1) and between Y–1 and Y+2 (ΔPR2%, ΔPR2). Subgroup analyses of PR were performed by player position, injury type, and years of experience. Results: Overall, 668 ankle injuries were identified, with an average cumulative incidence across the 3 seasons of 11.2% and RTP rate of 91%. Of those injuries, 159 met inclusion criteria for the PR analysis. The mean overall PR (96.95 in Y–1) declined 22% in Y+1 to 76.10 (–20.85 [95% CI, –13.82 to –27.89]; P < .001) and 27% in Y+2 to 70.93 (–26.02 [95% CI, –18.04 to –34.00]; P < .001). The mean PR per game played (6.70 in Y–1) decreased 14% in Y+1 to 5.75 (–0.95 [95% CI, –0.56 to –1.34]; P < .001) and 17% in Y+2 to 5.54 (–1.16 [95% CI, –0.63 to –1.62]; P < .001). Conclusion: It was found that ankle injuries hampered the performance of NFL players, even multiple years after the injury occurred, despite a relatively high RTP rate. There was a decrease in total games played after ankle injuries as well as a decreased performance output per game played.
Background: Textbook knowledge and clinical dogma are often insufficient for effective evidence-based decision making when treating musculoskeletal injuries in American football players, given the variability in presentation and outcomes across different sports and different levels of competition. Key evidence can be drawn directly from high-quality published articles to make the appropriate decisions and recommendations for each athlete’s unique situation. Purpose: To identify and analyze the 50 most cited articles related to football-related musculoskeletal injury to provide an efficient tool in the arsenal of trainees, researchers, and evidence-based practitioners alike. Study Design: Cross-sectional study. Methods: The ISI Web of Science and SCOPUS databases were queried for articles pertaining to musculoskeletal injury in American football. For each of the top 50 most cited articles, bibliometric elements were evaluated: citation count and density, decade of publication, journal, country, multiple publications by the same first author or senior author, article content (topic, injury area), and level of evidence (LOE). Results: The mean ± SD number of citations was 102.76 ± 37.11; the most cited article, with 227 citations, was “Syndesmotic Ankle Sprains” published in 1991 by Boytim et al. Several authors served as a first or senior author on >1 publication, including J.S. Torg (n = 6), J.P. Bradley (n = 4), and J.W. Powell (n = 4). The American Journal of Sports Medicine published the majority of the 50 most cited articles (n = 31). A total of 29 articles discussed lower extremity injuries, while only 4 discussed upper extremity injuries. The majority of the articles (n = 28) had an LOE of 4, with only 1 article having an LOE of 1. The articles with an LOE of 3 had the highest mean citation number (133.67 ± 55.23; F = 4.02; P = .05). Conclusion: The results of this study highlight the need for more prospective research surrounding the management of football-related injury. The low overall number of articles on upper extremity injury (n = 4) also highlights an area for further research.
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