Increased sensitivity to traumatic axonal injury on postconcussion diffusion tensor imaging scans in National Football League players by using premorbid baseline scans.

Objective: Statistical challenges exist when using diffusion tensor imaging (DTI) to assess traumatic axonal injury (TAI) in individual concussed athletes. The authors examined active professional American football players over a 6-year time period to study potential TAI after concussion and assess optimal methods to analyze DTI at the individual level.

Methods: Active American professional football players recruited prospectively were assessed with DTI, conventional MRI, and standard clinical workup.

Engaging Athletic Trainers in Concussion Detection: Overview of the National Football League ATC Spotter Program, 2011-2017.

Objective: To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters.

Background: Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries.

National Football League Head, Neck and Spine Committee's Concussion Diagnosis and Management Protocol: 2017-18 season.

One of the National Football League's (NFL) Head, Neck and Spine Committee's principal goals is to create a 'best practice' protocol for concussion diagnosis and management for its players. The science related to concussion diagnosis and management continues to evolve, thus the protocol has evolved contemporaneously. The Fifth International Conference on Concussion in Sport was held in Berlin in 2016, and guidelines for sports concussion diagnosis and management were revised and refined.

Distal Fibula Fractures in National Football League Athletes.

Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes' season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition.

Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes.

Study Design: Descriptive epidemiology study.

Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes.

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied.

Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play.

Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes.

Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns.

Purpose: To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team.

Midfoot sprains in the National Football League.

Midfoot sprains in the National Football League (NFL) are uncommon. There are few studies on midfoot sprains in professional athletes, as most studies focus on severe traumatic injuries resulting in Lisfranc fracture-dislocations. We conducted a study to evaluate midfoot sprains in NFL players to allow for better identification and management of these injuries.

Pressurized Intravenous Fluid Administration in the Professional Football Player: A Unique Setting for Venous Air Embolism.

Venous air embolism (VAE) is a potentially life-threatening event that is most commonly associated with certain surgical procedures, although this theoretical complication of pressurized rapid infusion of intravenous (IV) fluids has been described. This series of cases describes 4 athletes who presented with continuous coughing and other chest complaints after peripheral IV infusion of normal saline through manual pressurized infusion. Symptoms resolved within 20 minutes, and these incidences did not interfere with resuming athletic competition with no recurrence of symptoms or complications.

Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL.

Background: Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data.

Questions/purposes: The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player's ability to return to play and possible adverse effects.

Syndesmosis and lateral ankle sprains in the National Football League.

Syndesmosis sprains in the National Football League (NFL) can be a persistent source of disability, especially compared with lateral ankle injuries. This study evaluated syndesmosis and lateral ankle sprains in NFL players to allow for better identification and management of these injuries. Syndesmosis and lateral ankle sprains from a single NFL team database were reviewed over a 15-year period, and 32 NFL team physicians completed a questionnaire detailing their management approach.

Operative and nonoperative treatment of cervical disc herniation in National Football League athletes.

Background: Limited evidence exists to guide clinical decision making regarding cervical disc herniations in professional athletes playing for the National Football League (NFL) in the United States.

Purpose: To describe the presentation and treatment outcomes of cervical disc herniations in NFL athletes with a focus on safety and return to sport.

Study Design: Case series; Level of evidence, 4.

Epidural steroid injection for lumbar disc herniation in NFL athletes.

Purpose: To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players.

Methods: We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010.

Lower cervical posterior element fractures in the National Football League: a report of 2 cases and a review of the literature.

Background And Importance: Injuries in professional football players are common because of the nature of the collisions and the frequency of axial loading to the cervical spine. These injuries should be thoroughly evaluated because they can put the player at risk of future injury and even paralysis. The focus of this report is to present 2 cases of this injury and review the current body of literature.

Nonoperative Management of Complete Lateral Elbow Ligamentous Disruption in an NFL Player: A Case Report.

Disruptions of the lateral soft tissue restraints of the elbow, including the lateral ulnar collateral ligament, are a well-recognized clinical entity which may result in chronic elbow instability. When symptomatic, most authors recommend surgery to reconstruct the LUCL. We report on a case of a professional football player who sustained complete disruption of the lateral collateral ligamentous complex from the lateral humeral epicondyle with extension of his injury into his common extensor origin.

Effect of shoulder stabilization on career length in national football league athletes.

Background: Shoulder instability and surgical stabilization are common in college football athletes. The effect of shoulder stabilization during college on the length of an athlete's career in the National Football League (NFL) has not been well examined.

Hypothesis: Athletes with a history of shoulder stabilization before the NFL combine have a shorter career than do matched controls.

Effect of hyperconcavity of the lumbar vertebral endplates on the playing careers of professional american football linemen.

Background: Hyperconcavity of the lumbar spine has been found in a disproportionate percentage of college football lineman evaluated at the National Football League (NFL) Combine compared with age-matched controls.

Hypothesis: College football linemen with hyperconcavity of the lumbar spine are more likely to play in the NFL and to have a longer career in professional football.

Study Design: Cohort study; Level of evidence, 3.

Knee articular cartilage injuries in the National Football League: epidemiology and treatment approach by team physicians.

This study describes the epidemiology of knee articular cartilage injuries in the National Football League (NFL) and the typical treatment approach by NFL team physicians. All knee articular cartilage injuries in the league database from 1992 to 2006 were reviewed, and team physicians were surveyed about their treatment approach to these injuries. A total of 118 cases were identified, for an average of 8 per year, with a higher injury rate during games compared with practice.

Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case control study.

Background: Meniscal and anterior cruciate ligament (ACL) injuries are common in college football athletes. The effect of meniscectomy and/or ACL surgery on the length of an athlete's career in the National Football League (NFL) has not been well examined.

Hypothesis: Athletes with a history of meniscectomy or ACL surgery before the NFL combine have a shorter career than matched controls.