How ACL reconstruction and/or meniscectomies can affect NFL players' careers

With the NFL season now moving along in full swing, the incidence of injuries and players sitting out for extended periods of time will continue to remain a major factor that will accompany it. Two of the most common injuries found in football are those related to the meniscus and the anterior cruciate ligament (ACL), two parts of the knee that suffer greatly when sudden changes of direction are performed incorrectly or with interference. Of the potential NFL players who attend the annual NFL Scouting Combine every year, 12% will have a history of a meniscal injury, while 8% will have one with their ACL. As a result, a meniscectomy (partial or full removal of the meniscus) is the most common procedure performed on players at the combine, found in 10% of athletes, while ACL reconstruction is the third most common injury, found in 6% of players. Despite the overwhelming prevalence of such injuries, there is a lack of evidence that investigates the long-term effects of these procedures and if they have permanent implications on players' careers and playing ability. A case control study published by the American Journal of Sports Medicine looked back at information from combines in the past to determine the impact of having either or both of these procedures.

The source of the information used for the study was a database that held medical records of all athletes who attended the NFL Scouting Combine between 1987-2000, which totaled out at 5,047, with 2,845 players actually going on to play in at least one NFL game. All players who underwent a meniscectomy or ACL reconstruction at some prior to the combine were assessed more closely to seek out ideal candidates who had not suffered any other major injuries to the area that might throw off the study. Controls, who had not suffered any serious injury to either the ACL or meniscus, were matched up to each qualified participant of the study based on their year and placement in the draft, as well as additional injury history to shoot for similar subjects. The primary criteria used to determine the effect of the procedures on each subject were years in the league and number of games played.

A total of 94 subjects were used for the study: 54 with an isolated history of a meniscectomy, 29 with an isolated history of ACL reconstruction and 11 with a history of both procedures. Most controls were matched closely with subjects of the study. Results showed that those who had an isolated meniscectomy had shorter careers and played in fewer games than controls. For the isolated ACL reconstruction group, the length of career and number of games played was closely related to that of the controls. No significant data was extracted for those who experienced both procedures since the number of subjects in the category was so small.

There are a small number of limitations on this study: the trial size was small, particularly in the group of subjects who underwent both procedures, the nature of the study looked retrospectively at earlier evidence rather than prospectively, and it also failed to include information on meniscal repairs in addition to meniscectomies since that information was unavailable. Even with the limitations considered, however, the study still proved that ACL reconstruction is a reliable surgical technique that enables athletes to have careers with similar lengths to their counterparts who don't endure that form of surgery. Meniscectomies, on the other hand, lead to shorter careers for athletes who experience them, suggesting that repairing an injured meniscus or debriding (removing) the least amount of the meniscus possible could likely be the better course of action to take in order to extend an athlete's career.

-As reported in a study conducted by Washington University School of Medicine, the Hospital for Surgery and the New York Giants and reported in The American Journal of Sports Medicine

-By Greg Gargiulo