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High rate of return to play found among NFL players after treatment for shoulder instability
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National Football League players experienced a high rate of return to play after shoulder instability, regardless of treatment modality, according to results.
Among 83 NFL players who sustained an in-season shoulder instability event, Kelechi R. Okoroha, MD, and colleagues collected NFL return to play, incidence of surgery, time to return to play, recurrent instability events, seasons/games played after the injury and demographic data. Researchers determined overall return to play and compared players who underwent operative repair to players who had nonoperative treatment.
Results showed 92% of NFL players who sustained either a shoulder subluxation or a dislocation and did not undergo surgical repair returned to NFL regular season play at a median of 0 weeks and 3 weeks, respectively. Researchers found a median return to play of 39.3 weeks among players who underwent operative repair.
A recurrent instability event occurred in 47% of players. Researchers noted a lower recurrence rate and longer interval between a recurrent instability event among players who underwent surgical repair and were able to return to play.
“Regardless of treatment modality, there is a high rate of [return to play] RTP following shoulder instability events in NFL players,” Okoroha told Healio.com/Orthopedics. “Players who sustain shoulder subluxations RTP faster, but also have earlier recurrent instability events compared to players with dislocations. In NFL athletes who have surgery following shoulder instability, there is a decreased incidence of subsequent instability and a longer event-free interval compared to players who do not have surgery.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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Brett D. Owens, MD
Dr. Okoroha and colleagues utilized publicly accessible injury press reports from NFL players over an 8-year period and found 83 players (72 dislocations and 11 subluxations). They found that most athletes (93%) were able to RTP following the initial event, however half (46%) experienced a recurrent event. Although RTP was faster for athletes with subluxations compared with dislocations (3 weeks vs. 0 weeks), their risk of recurrence was the same (44% vs. 46%). Not surprisingly, the risk of recurrence was significantly reduced with surgical intervention compared with nonoperative management (26% vs. 55%).
The authors are commended for their efforts. Their data certainly comes with significant limitations, such as the accuracy of public disclosure of NFL injuries. They also were not able to determine the athletes’ previous history of shoulder instability or surgery. While the diagnosis of a glenohumeral dislocation is clear, a subluxation event can be subtler. In addition, this cohort may include posterior instability athletes as the authors were unable to differentiate directionality. Overall, their data support previous multicenter prospective studies in the NCAA population.
The take home message is that although collision athletes are able to successfully RTP following an initial shoulder instability event, recurrent instability occurs at a high rate. As we further clarify the pathologic repercussions of each subsequent recurrent instability event, the importance of early surgical stabilization in high-risk athletes only continues to increase.
References:
Dickens JF, et al. Am J Sports Med. 2014;doi:10.1177/0363546514553181.
Dickens JF, et al. Am J Sports Med. 2017;doi:10.1177/0363546517712505.
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