Prospective NFL athletes with a previous posterior cruciate ligament injury who were treated non-operatively played more games during the first two years of their NFL career than those treated operatively.
Posterior cruciate ligament (PCL) injures can have detrimental effects on a professional athlete's career. Understanding the epidemiology, examination, imaging findings, and subsequent outcomes of PCL injuries in collegiate football players at the NFL Combine will offer insight to better counsel players. The purposes of this study are to 1) determine the epidemiology, examination, imaging findings and associated injuries of PCL injuries in players participating in the NFL Combine, 2) to identify positions that are at higher risk for sustaining these injuries, and 3) to evaluate the impact of PCL injury on NFL draft position and play outcomes compared to matched controls.
Over a 7-year period (2009-2015), all PCL injuries identified at the NFL Combine were reviewed. Medical records, imaging, associated injuries and treatment were reviewed, as well as surgeries, games missed, position played and draft position of each player. NFL performance outcomes (draft position and number of games played and started within first two years) were assessed for all PCL injuries over 5 years (2009-2013) versus controls matched to position. Odds ratios were calculated using logistic regression to assess the risk of sustaining each injury by position. Two-sample, two-tailed T-tests were computed to assess differences in player outcomes in offensive versus defensive players.
2285 players participated in the NFL Combine between 2009 and 2015, with 77 (3.4%) PCL injuries identified and 62 (80.5%) were isolated injuries. The 15 athletes with a combined injury included 11 athletes with concurrent medial collateral ligament (MCL) injury with or without additional ligamentous injuries. Magnetic resonance imaging (MRI) was available for 75/77 athletes. There were 36/77 (46.7%) PCL-injured knees with additional soft tissue structures injured: 24 (66.7%) MCL, 10 (27.8%) meniscus, 7(19.4%) anterior cruciate ligament, and 5 (13.8%) posterolateral corner. Chondral injury was noted in 23 (30.7%) of PCL-injured knees with the majority involving the medial femoral condyle (MFC) (43.5%). Running backs were at increased risk of having an injury involving the PCL (OR 2.24, p=0.005). Compared to defensive players, offensive players were more likely to have an injury involving the PCL (OR 1.6, p = 0.039). These findings were not observed in isolated PCL injury. Thirty athletes (39%) with PCL injury went undrafted. Although not statistically significant, offensive players fared worse in mean draft pick number (133.6 versus 100.8). The PCL injury was managed surgically in 13 cases (16.8%). There were 41 PLC injuries in the matched control analysis, where a total of 31.7% (13/41 players) with isolated PCL injury went undrafted, compared to 28.4% in the control group. Despite no statistical significance, isolated PCL group fared worse than controls in mean draft pick number (123.2 versus 111.3), mean games played (22.1 versus 23.3) and mean games started (9.9 versus 10.5). The non-operative group played significantly more games than the operative group during the first two years of their NFL career (23.2 versus 13, p=0.02).
Discussion And Conclusion
A small percentage (3.4%) of players at the NFL combine had a history of PCL injury. Isolated PCL injuries in college were usually treated non-operatively, and many presented with additional injuries to the MCL and MFC cartilage. Athletes who were treated non-operatively played more games during the first two years of their NFL career. PCL injuries identified at the NFL Combine fared well in terms of draft order pick, initial play and overall outcomes during initial NFL career.