2015 ISAKOS Biennial Congress ePoster #1230

The Incidence of Recurrent and Contralateral ACL Injury in National Football League Players

Christopher C. Dodson, MD, Philadelphia, PA UNITED STATES
Eric Secrist, BS, Philadelphia, PA UNITED STATES
Peter F. DeLuca, MD, Philadelphia, PA UNITED STATES
Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Daniel Woods, MD, Philadelphia, PA UNITED STATES

The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA

FDA Status Not Applicable

Summary: This epidemiologic study defined the incidence of recurrent ACL and contralateral ACL injuries in NFL players in 2013 and illustrates that both are significant problems for the NFL athlete.




This cross-sectional epidemiological study intended to characterize all anterior cruciate ligament (ACL) tears in NFL players between the 2010 and 2013 seasons.


An exhaustive online search was rigorously conducted to isolate any NFL player who had suffered a publicly disclosed ACL injury between the 2010 and 2013 NFL seasons. This involved the use of the NFLISS database, ESPN.com, Rotoworld.com, NFL.com, and newspapers, blogs and media guides for each team. Only injuries for which a reliable media report describing the injury could be obtained were included. Each injury incidence was characterized according to player position, playing surface, timing (in-game, practice or offseason), date and concomitant injuries. Each player identified as having suffered an ACL injury was individually researched for any history of previous ACL injury. A database of NFL games from USA Today was used to determine the number of games played on each playing surface. A database from Pro Football Focus of all players who appeared in NFL games between 2010 and 2013 was used to determine the number of players who had participated at each position and this was used to calculate the relative injury rates of each position.


There were 220 ACL injuries in NFL players between 2010 and 2013, an average of 55 injuries per season. August (59) had the highest incidence of any month. There were 146 injuries (66%) which occurred during games.
Forty players (18.2 %) had suffered at least one previous ACL injury. Of these, 27 players (12.3 %) retore a previously injured ACL, and 16 (7.3 %) had previously injured the ACL in their contralateral knee. This was the third ACL injury for 7 players (3.2 %).
Thirty eight players (17.3 %) injured at least one other ligamentous or tendinous structure, with 29 (13.2 %) injuring their MCL, 6 (2.7 %) injuring their PCL, 4 (1.8 %) injuring their LCL and 3 (1.4 %) injuring their patellar tendon.
A subset of skilled position players (WR - 10.6 %, LB - 7.7 %, RB - 7.3 %, CB - 6.9 %, TE - 6.4 %) had the highest rates of injuries per total NFL players. Interior linemen (OG - 5.6 %, DT - 5.4 %, C - 5.1 %) composed the next highest risk group. This was followed by the other skilled position players (S - 3.7 %, QB 3.2 %, FB - 3.1 %). Perimeter linemen, (DE - 3.0 %, OT - 2.9 %) had the lowest injury rates of any position players. Specialists (P - 2.8 %, K - 2.0 %) had the lowest incidence and the lowest injury rates.
ACL injury rates per team games played were .050 for grass and .053 for turf fields (p>.05).


Roughly 1 in 5 ACL NFL players who injured their ACL between 2010 and 2013 had previously suffered at least one ACL injury, the majority of these injuries occurring in the same knee. The greatest number of injuries occurred during the preseason, although this could be due to team rosters consisting of 90 players during the preseason as opposed to 63 during the regular season. Skilled position players and interior linemen carried the highest ACL injury risk. There was no correlation between playing surface and incidence of ACL injuries.