Return to Play and Performance Measures for National Football League Athletes Following Operative Ankle Fractures

Abstract

Category: Sports; Ankle; Trauma Introduction/Purpose: Ankle fractures are common injuries in the National Football League (NFL). Yet, there is a need for deeper understanding about the impacts of surgically managed ankle fractures on athletes' careers. Purpose: To investigate return to play (RTP) for NFL players after operative ankle fractures and the associated impacts on career longevity and player performance. Methods: NFL athletes that underwent surgery to repair ankle fractures between 2013 and 2018 were identified from injury reserve (IR) list transactions and press release archives. Athlete demographics and regular season metrics were collected for the seasons before and after injury. Athletes were then matched to uninjured controls. Statistical analysis was performed to evaluate for differences in recorded variables. Results: Of the 46 NFL athletes screened, 31 players fit study criteria. Nine (29.0%) players with surgically treated ankle fractures were unable to return to play in the NFL. Compared to the twenty-two (71.0%) athletes that successfully returned to play, players that did not RTP were no different (P > .05) in age, BMI, number of games or seasons played prior to injury, or snaps per game the season prior to injury. Players that did not RTP had a significantly lower (42.6%, P = .013) pre-injury season approximate value (SAV) from players that did RTP. Athletes that successfully returned to play spent an average of 98 days on IR and continued playing for 41 games across 3.5 seasons. There were no differences (P > .05) in SAV or snaps per game at 1 or 2 seasons following injury when compared to the athletes' pre-injury season or when compared to uninjured controls. Conclusion: NFL athletes that receive surgery to repair ankle fractures have a RTP rate of 71%. A high pre-injury SAV is a positive predictive measure for successful RTP. NFL players that do return see no difference in game time or performance metrics from pre-injury baseline or uninjured controls.