For athletes who make it to the NFL, an ACL injury in college significantly reduces the number of games played and started, compared to matched controls, but did not appear to significantly impact position-specific game performance for most players.
Anterior cruciate ligament (ACL) injuries remain among the most common injuries in high-level football players. While prior studies have reported on the epidemiology of injuries in collegiate and national football league (NFL) athletes, there is a paucity of information available on the impact of ACL injury on draft prospects and professional performance. The purpose of this study was to define the epidemiology of ACL injuries in NFL athletes, and to determine the impact of these injuries on draft status and performance in the NFL.
All NFL-caliber athletes who attended the NFL Scouting Combine between 2009 and 2015 were analyzed for history of knee ligamentous injury. Athletes with ACL injuries were compared to control Combine athletes, which were defined as athletes with no history of knee injury in college, no surgical history, and no history of missing > 2 total games in college. The impact of ACL injury on NFL draft pick status and NFL performance, including games started, games played, and position-specific performance outcomes, was analyzed and compared to control Combine athletes.
A total of 197 athletes, representing 8.9% of all athletes at the Combine, had a history of ACL injury, with 11 athletes (5.6%) also having contralateral ACL injuries. The majority of athletes (87.3%) underwent ACL reconstruction (ACLR), with 25 (12.7%) athletes reporting nonoperative treatment. Athletes with an ACL injury were more likely to be undrafted (38.1% vs 29.3%) and had a lower overall draft pick (125.7±74.5 vs 109.0±68.8) compared to controls (p<0.01 for both). Athletes with an ACL injury played (21.3±8.5) and started (7.0±8.7) fewer games in their first 2 seasons in the NFL compared to controls (23.1±8.1, p<0.05 and 10.8±10.6, p<0.01, respectively, Figure 1). The frequency of ACL injuries was comparable among offensive (N=46, 7.6%) and defensive (N=49, 8.1%) players. Running backs (12.1%, OR=1.8, p<0.05), tight ends (15.3%, OR=2.1, p<0.05) and defensive lineman (11.3%, OR=1.55, p<0.01) were at increased risk of having an ACL injury, while offensive lineman (3.6%, OR=0.38, p<0.05) and defensive backs (5.1%, OR=0.54, p<0.05) were at decreased risk. Defensive backs with an ACL injury had fewer interceptions in their first two seasons (0.8±1.1) compared to position-matched controls (2.1±2.3, p<0.05). Defensive lineman with an ACL injury had nearly half as many quarterback hits (5.9±6.9) compared to position-matched controls (10.5±11.5, p<0.05).
Discussion And Conclusion
History of ACL injury in NFL-caliber players significantly lowers draft status and overall draft pick compared to matched controls. For athletes who make it to the NFL, an ACL injury in college significantly reduces the number of games played and started, compared to matched controls, but did not appear to significantly impact position-specific game performance for most players.