What Is The Most Common Football Orthopedic Surgery Injuries?

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December 4, 2023
Football player running with ball
Football is one of the most popular and exciting sports in the world, but also one of the most demanding and risky for the players’ health. Injuries are inevitable in a game that involves high-speed collisions, sudden changes of direction, and intense physical contact. Some of the injuries can be treated conservatively with rest, ice, compression, and elevation (RICE), while others require surgical intervention to restore function and allow return to play.

But what is the most common orthopedic surgery for football players? According to a review of the National Football League (NFL) injury data, the most frequent surgical procedures performed on NFL players are anterior cruciate ligament (ACL) reconstruction, Achilles tendon repair, and patellar tendon repair. These three surgeries account for more than half of all orthopedic operations in the NFL and have a significant impact on the players’ careers and performance.

ACL Reconstruction

ACL Injury DiagramThe ACL is one of the four major ligaments that stabilize the knee joint. It prevents excessive forward movement of the tibia (shin bone) relative to the femur (thigh bone), and also helps control rotational stability of the knee. The ACL can tear when the knee is twisted or hyperextended, often as a result of landing awkwardly, changing direction abruptly, or being hit by another player. ACL tears are very common in football, especially in positions that involve cutting and pivoting movements, such as running backs, wide receivers, and defensive backs.

ACL reconstruction surgery involves replacing the torn ligament with a graft, usually taken from another part of the patient’s body (autograft) or from a donor (allograft). The most common sources of autografts are the patellar tendon, which connects the kneecap to the tibia, and the hamstring tendons, which run along the back of the thigh. The choice of graft depends on several factors, such as the patient’s age, activity level, preference, and potential complications. Historically, the majority of professional athletes who have undergone ACL reconstruction surgery have had a patellar tendon autograft. The central third of the patellar tendon is harvested along with a 1-inch section of bone taken from both the patella and the tibia onto which the tendon attaches. The bone-patellar tendon-bone (BPTB) graft is then inserted into tunnels drilled in the femur and tibia, then fixed with screws or other devices. The advantages of this technique are that it provides a strong graft with good bone-to-bone healing, and that it allows for early and aggressive rehabilitation. The disadvantages are that it may cause more pain and stiffness in the donor site, increase the risk of patellar fracture or tendon rupture, and affect the function of the extensor mechanism of the knee.

Alternatively, some athletes opt for a hamstring autograft, which involves taking one or two tendons from the back of the thigh and folding them to create a four-strand graft. The hamstring graft is then passed through tunnels in the femur and tibia and fixed with screws or other devices. The advantages of this technique are that it causes less pain and morbidity at the donor site, preserves the patellar tendon and its function, and may provide better rotational stability of the knee. The disadvantages are that it may result in weaker graft fixation and slower bone-to-bone healing, and that it may compromise the strength and endurance of the hamstring muscles.

The success rate of ACL reconstruction surgery is generally high, with more than 80% of patients returning to their pre-injury level of activity; however, there are several factors that can affect the outcome of the surgery, such as the timing of the operation, the type and quality of the graft, the surgical technique, the rehabilitation protocol, and the presence of associated injuries. Moreover, some studies have shown that ACL reconstruction surgery may not prevent the development of osteoarthritis in the long run.

Achilles Tendon Repair

The Achilles Tendon DiagramThe Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles to the heel bone and enables plantar flexion of the foot (pointing the toes downward). The Achilles tendon can rupture when it is overstretched or subjected to excessive force, often as a result of pushing off or landing on a hard surface. Achilles tendon ruptures are relatively rare in football, but they tend to occur more frequently in older players (>30 years old), especially those who play positions that require explosive acceleration or deceleration, such as running backs or linebackers.

Achilles tendon repair surgery involves stitching together the torn ends of the tendon, usually through an incision on the back of the ankle. The advantages of surgical repair are that it restores the normal anatomy and strength of the tendon, and that it reduces the risk of re-rupture or chronic weakness. The disadvantages are that it may cause more pain and scarring, increase the risk of infection or wound healing problems, and require a longer period of immobilization and rehabilitation.

The success rate of Achilles tendon repair surgery is also high, with more than 80% of patients returning to their pre-injury level of activity; however, the recovery time is usually longer than that of ACL reconstruction surgery, ranging from 6 to 12 months. Some of the factors that can affect the outcome of the surgery are the severity and location of the tear, the surgical technique, the rehabilitation protocol, and the patient’s age and general health.

Patellar Tendon Repair

Patellar Tendon Rupture DiagramThe patellar tendon is a continuation of the quadriceps tendon, which connects the four muscles of the front of the thigh to the kneecap. The patellar tendon then attaches the kneecap to the tibia, forming part of the extensor mechanism of the knee. The patellar tendon can tear when it is subjected to excessive force or stress, often as a result of jumping or landing on a flexed knee. Patellar tendon tears are uncommon in football, but they tend to occur more frequently in players who have a history of patellar tendinitis (inflammation of the tendon) or steroid injections.

Patellar tendon repair surgery involves suturing together the torn ends of the tendon, usually through an incision on the front of the knee. The advantages of surgical repair are that it restores the normal anatomy and function of the extensor mechanism, and that it allows for early and progressive rehabilitation. The disadvantages are that it may cause more pain and stiffness in the knee, increase the risk of patellar fracture or tendon re-rupture, and affect the outcome of a future ACL reconstruction surgery if needed.

The success rate of patellar tendon repair surgery is lower than that of ACL reconstruction or Achilles tendon repair surgery, with only about 60% of patients returning to their pre-injury level of activity. Moreover, patellar tendon repair has been shown to have the greatest effect on NFL careers, with a significant decrease in games played and performance after surgery. Some of the factors that can affect the outcome of the surgery are the size and location of the tear, the surgical technique, the rehabilitation protocol, and the presence of associated injuries or comorbidities.

Conclusion

In conclusion, ACL reconstruction, Achilles tendon repair, and patellar tendon repair are the most common orthopedic surgeries for football players. These surgeries can help restore function and allow return to play, but they also have potential complications and limitations. Therefore, football players should be aware of the risks and benefits of these procedures and follow a proper prevention and rehabilitation program to optimize their recovery and performance.

Dr. Stowell is one of the leading orthopedic surgeons in the United States. If you would like to consult with Dr. Stowell for any of your orthopedic injuries, please call (208) 457-4211.

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