The treatment of Lumbar Disc Herniation (LDH) in elite athletes is a debated topic that lacks consensus in the literature due to varying outcome reporting methods. The objective of this study was to quantify the overall performance of a sample of professional athletes before and after receiving a lumbar discectomy or microdiscectomy in a cohort of players in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL) and Major League Baseball (MLB). METHODSThe authors identified publicly accessible data from a cohort of different types of professional players who received either a lumbar discectomy or a microdiscectomy. These records were identified through newspaper archives, injury reports, player profiles and press releases between 1993 through 2015. Fantasy and Wins Above Replacement (WAR) scores were calculated for each player. RESULTSA total of 38 professional players met study inclusion criteria. NFL players had the lowest return-to-play (RTP) at nine of 14 (64%). The RTP for NBA, NHL and MLB players were comparable with 6/7 (86%) vs 8/9 (89%) vs 7/8 (88%). NFL players had the lowest average career length after surgery at 34.8 months, while NBA players had the longest average career length at 48 months. MLB players on average required the longest time to return to presurgical level of performance (24 months) and required the longest average recovery time at 12 months. CONCLUSIONSBased on these results, the average performance of most elite athletes are likely to decrease after undergoing a lumbar discectomy. Although it appears that performance peaks in the initial years after the operation for some players, there was an overall long-term decline in this sample of elite athletes. Study limitations included small sample size, lack of controlling for possible confounding variables (e.g., age, etc.) and use of variable reporting sources. Additional studies with larger sample sizes and age-matched controls are needed to examine the effects of lumbar discectomy more comprehensively in elite athletes.

Our aim in performing this study was to evaluate whether fantasy and wins above replacement (WAR) scores of athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) could be utilized in evaluating their performance post-surgery. We identified publicly accessible data on professional athletes from 1992 to 2015. Fantasy and WAR scores were calculated for each player. A total of 83 professional players met the inclusion criteria for this cross-sectional study. Decreased fantasy scores ranged from 33% to 42% across the four leagues after the index operation. NHL players had the lowest return-to-play (RTP) rate at 11/17 (82%), and MLB players had the highest RTP rate at 14/15 (93%). RTP rates of NBA and NFL players were comparable at 22/26 (85%) and 22/25 (88%), respectively. NFL players had the lowest average career length after surgery at 26 months, while NBA players had the longest average career length at 64 months. MLB players on average required the longest time to return to the presurgical level of performance (21 months). NHL players had the shortest average recovery time (eight months), and NBA players had the longest average recovery time (13 months). Approximately, more than half of all the studied players exhibited a decline in fantasy or WAR scores. In addition, NFL players had the lowest average career length, and NBA players enjoyed the longest average career length after surgery. NHL players had the lowest recovery time, while NBA players had the longest recovery time. The strength of this study is the utilization of fantasy points and WAR scores as a single unifying measure of a player's performance, which acts as an objective measure after ACL reconstruction. The average performance of a professional athlete, as evaluated through their fantasy score output, tends to decrease after undergoing ACL reconstruction. There is an overall long-term performance decline after initial spikes in their performance after surgery. Additional larger studies are needed to fully understand the effects of ACL reconstruction in professional athletes; however, the use of fantasy scores may be an objective tool in measuring the success rate of ACL reconstruction.