Predictive Value of Prior Injury on Career in Professional American Football Is Affected by Player Position

Background: The National Football League holds an annual combine where individual teams evaluate college football players likely to be drafted for physical skills, review players' medical history and imaging studies, and perform a physical examination. Purpose: The purpose of this study was to test the effect of specific diagnoses and surgical procedures on the likelihood of playing and length of career in the league by position. Study Design: Cohort study; Level of evidence, 3. Methods: A database for all players reviewed at the annual National Football League Combine by the medical staff of 1 National Football League team from 1987 to 2000 was created, including each player's orthopaedic rating, diagnoses, surgical procedures, number of games played, and number of seasons played in the National Football League. Athletes were grouped by position as follows: offensive backfield, offensive receiver, offensive line, quarterback, tight end, defensive line, defensive secondary, linebacker, and kicker. The percentage of athletes who played in the National Football League was calculated by position for each specific diagnosis and surgery. Results: The effect of injury on the likelihood of playing in the league varied by position. Anterior cruciate ligament injury significantly lowered the likelihood of playing in the league for defensive linemen (P = .03) and linebackers (P = .04). Meniscal injury significantly reduced the probability of playing (P < .05) and length of career (P = .002) for athletes in the defensive secondary. Shoulder instability had a significant effect on playing in the league for offensive (P = .03) and defensive linemen (P = .02), and shortened the length of career for defensive linemen (P = .016). Spondylolisthesis did not significantly reduce the chance of playing in the league for any position, while a history of spondylolysis had a significant effect for running backs (P = .01). Miscellaneous injuries (eg. acromioclavicular joint, knee medial collateral ligament, carpal fractures) had isolated position-specific effects. Conclusion: The significant injuries and diagnoses appear congruent with the position-specific demands placed on the athletes. This information is useful to physicians and athletic trainers caring for college football athletes as well as those assessing these athletes at the National Football League Combine.