National Football League Football Research Articles

Weekend (Keyboard) Warriors: Differences in Social Media Consumption and Production Between NFL and College Football Fans

Sports fans are often some of the most passionate groups of fans and the use of social media can intensify those feelings, both in expressing their feelings and consumption of content. Football fans are a unique group in American sports culture, but how much difference is there within that group in terms of these behaviors? Using a social identity approach, this manuscript analyzed the degree to which team identification and fan identification played a role in the social media consumption and production in college football and National Football League (NFL) fans. A total of 586 fans responded to a survey that examined respondent’s team and fan identification, as well as social media consumption, creation, and sharing behaviors. Results indicated that college football fans generally identified with fellow fans of their favorite football team and consumed, created, and shared social media more frequently and with greater intensity than their NFL counterparts. Key differences between college football and NFL fans included fan identification predicted social media consumption and creation, while team identification predicted social media sharing among both college and NFL fans.

Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes

ABSTRACT Objective Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment. Setting Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7). Design Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms. Results Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08). Conclusions Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC.

Increased spatial extent of cerebral tau PET elevations in former NFL and college football players from the DIAGNOSE CTE Research Project

AbstractBackgroundWe previously found greater spatial extent of flortaucipir (tau) PET elevations in Arizona‐Boston (DETECT) Study of 26 former National Football League (NFL) players than in 31 normal controls—using a voxel‐based Majority Count Statistics (MCS) algorithm which enabled us to detect tau PET abnormalities in the player group free from the inflated Type 1 error associated with voxel‐wise multiple comparisons (Stern et al, NEJM 2019). We now confirm this finding in a larger group of former NFL players, former college football players and asymptomatic controls without exposure to repetitive head impacts from the DIAGNOSE CTE Research Project.MethodFlortaucipir PET images were acquired in 106 former NFL players, 51 former college players, and 53 unexposed controls, 57.71+8.37 years of age. An automated algorithm (SPM12) and co‐registered MRIs were used to spatially normalize PET images into Montreal Neurological Institute template, and compute statistical brain maps of group differences in regional cerebral‐to‐cerebellar crus1 standard uptake value ratio (SUVR), controlling for the participants’ age and race with P≤0.005, uncorrected for multiple comparisons. Our MCS was then applied with 1,000 iterations to test the hypothesis that there would be a greater number of cerebral voxels with SUVR elevations in each and combined player group versus control group, as well as between the NFL versus college player groups.ResultAs predicted, the NFL, college player and aggregate player groups each had significantly more cerebral voxels with flortaucipir SUVR elevations than in the control group (postulated vs opposite directions: 53,879 vs 79, 79,552 vs 89 and 100,837 vs 86 voxels), respectively, MCS P&lt;0.001, but not between former NFL and former college players (482 versus 306, p = 0.305).ConclusionUsing a voxel based MCS analysis, former NFL and college football players have a greater spatial extent of elevations in tau PET measurements than asymptomatic controls. Additional work is needed to clarify the biological nature of these small but spatially extensive elevations, the extent to which they are related to symptom severity, cognitive performance, repetitive head impact exposure, and other risk or resilience factors, and the extent to which they are associated with subsequent clinical decline.

Association of National Football League Fan Attendance With County-Level COVID-19 Incidence in the 2020-2021 Season

The 2020-2021 National Football League (NFL) season had some games with fans and others without. Thus, the exposed group (ie, games with fans) and the unexposed group (games without fans) could be examined to better understand the association between fan attendance and local incidence of COVID-19. To assess whether NFL football games with varying degrees of in-person attendance were associated with increased COVID-19 cases in the counties where the games were held, as well as in contiguous counties, compared with games without in-person attendance for 7-, 14-, and 21-day follow-ups. This cross-sectional study used data for all 32 NFL teams across the entirety of the 2020-2021 season. Separate daily time-series of COVID-19 total cases and case rates were generated using 7-, 14-, and 21-day simple moving averages for every team and were plotted against the actuals to detect potential spikes (outliers) in incidence levels following games for the county in which games took place, contiguous counties, and a combination. Outliers flagged in the period following games were recorded. Poisson exact tests were evaluated for differences in spike incidence as well across games with different rates of attendance. The data were analyzed between February 2021 and March 2021. Games with fan attendance vs games with no fan attendance, as well as the number of fans in attendance for games with fans. The main outcome was estimation of COVID-19 cases and rates at the county and contiguous county level at 7-, 14-, and 21-day intervals for in-person attended games and non-fan attended games, which was further investigated by stratifying by the number of persons in fan-attended games. This included a total of 269 NFL game dates. Of these games, 117 were assigned to an exposed group (fans attended), and the remaining 152 games comprised the unexposed group (unattended). Fan attendance ranged from 748 to 31 700 persons. Fan attendance was associated with episodic spikes in COVID-19 cases and rates in the 14-day window for the in-county (cases: rate ratio [RR], 1.36; 95% CI, 1.00-1.87), contiguous counties (cases: RR, 1.31; 95% CI, 1.00-1.72; rates: RR, 1.41; 95% CI, 1.13-1.76), and pooled counties groups (cases: RR, 1.34; 95% CI, 1.01-1.79; rates: RR, 1.72; 95% CI, 1.29-2.28) as well as for the 21-day window in-county (cases: RR, 1.49; 95% CI, 1.21-1.83; rates: RR, 1.50; 95% CI, 1.26-1.78), in contiguous counties(cases: RR, 1.37; 95% CI, 1.14-1.65; rates: RR, 1.45; 95% CI, 1.24-1.71), and pooled counties groups (cases: RR, 1.41; 95% CI, 1.11-1.79; rates: RR, 1.70; 95% CI, 1.35-2.15). Games with fewer than 5000 fans were not associated with any spikes, but in counties where teams had 20 000 fans in attendance, there were 2.23 times the rate of spikes in COVID-19 (95% CI, 1.53 to ∞). In this cross-sectional study of the presence of fans at NFL home games during the 2020-2021 season, results indicated that fan attendance was associated with increased levels of COVID-19 in the counties in which the venues are nested within, as well as in surrounding counties. The spikes in COVID-19 for crowds of over 20 000 people suggest that large events should be handled with extreme caution during public health event(s) where vaccines, on-site testing, and various countermeasures are not readily available to the public.

Transition-Related Psychosocial Factors and Mental Health Outcomes in Former National Football League Players: An NFL-LONG Study.

Transition from professional sport to nonsport endeavors has implications for postcareer health and well-being of athletes. The purpose of the current study was to examine associations among transition-related psychosocial factors and current mental health outcomes in former National Football League (NFL) players. Participants were former NFL players (n = 1,784; mean age = 52.3 ± 16.3years) who responded to a questionnaire assessing the nature of their discontinuation from professional football (i.e.,any degree of voluntary choice vs. forced discontinuation), prediscontinuation transition planning (yes vs. no), and current symptoms of depression and anxiety. After adjusting for relevant covariates, having an involuntary discontinuation and no transition plan prior to discontinuation were associated with greater depressive and anxiety symptom severity. Autonomy in discontinuation and pretransition planning are important to former NFL football players' mental health. Increasing autonomy in the discontinuation decision and pretransition planning represent psychoeducational intervention targets for this population.

Concussion is not associated with elevated rates of lower-extremity musculoskeletal injuries in National Football League Players

ABSTRACT Objective Emerging evidence has identified an ~2x elevated risk of musculoskeletal (MSK) injury in the year following a concussion. Most of these studies have examined a single college/university athletic department and may lack generalizability to professional sports. Therefore, the purpose of this study was to assess the odds of post-concussion MSK injury utilizing publicly available National Football League (NFL) injury reports. Methods Concussions were identified through a review of published NFL injury reports during the 2015, 2016, and 2017 regular seasons. Concussed players were matched by team and position, and injuries were tracked for both groups for the remainder of the season. A chi-square analysis compared the frequency of MSK injury in both groups and a Cox Proportional Hazard model calculated the risk of sustaining a subsequent MSK injury. Results There were 322 concussed NFL players who met inclusion criteria and were successfully matched. From the time of concussion through the remainder of the season, 21.4% of the concussed players were injured and 26.4% of control participants were injured. There was no difference in MSK injury rates (p = 0.166), and the relative risk ratio was 0.90 for subsequent injury in the concussion group. There was no difference in the time to event for subsequent MSK between the two groups (p = 0.123). Conclusion The primary finding of this study was no elevated risk of post-concussion MSK in NFL football players.

Preseason elimination impact on anterior cruciate ligament injury in the National Football League.

BACKGROUNDAnterior cruciate ligament (ACL) injuries represent detrimental injuries in the National Football League (NFL). A significant portion of these injuries often occur in preseason exhibitions. The Coronavirus disease 2019 pandemic presented a unique disruption to preseason NFL football with the cancelation of all preseason games. AIMTo compare the incidence of ACL tears through the first eight weeks of the NFL season in 2020 to the mean incidence over the previous 5 seasons (2015-2019) and determine if there was any change in incidence with the elimination of the preseason. METHODSNFL players who suffered ACL tears during the preseason and first eight weeks of the NFL season from 2015-2020 were identified. The number of ACL injuries for the 2015-2019 seasons was compared to the 2020 season for four different timeframes. For each analysis, the cumulative number of ACL injuries to that time point was used to calculate the percent difference for descriptive analysis. Additionally, the number of teams with at least one player suffering an ACL tear were identified and compared using Chi-Squared testing. Finally, a cumulative relative risk was calculated for each week played.RESULTSThere were 14 ACL tears through the first four games of the 2020 season, a 118.8% (14 vs 6.4) increase in comparison to the 5-year average over the first 4 regular season weeks of 2015-2019. However, when accounting for injuries occurring during the preseason from 2015-2019, there were 18.6% (14 vs 17.2) fewer total ACL injuries through regular season week 4 with no significant difference in percentage of teams impacted when these preseason injuries were accounted for P = 0.394. Results were similar (19 vs 17.2) over 8 total games played (whether regular season or preseason), and over 8 regular season games (P = 0.196, P = 0.600).CONCLUSIONThe elimination of the NFL preseason resulted in a higher rate of injuries during the first 4 games of the regular season. However, these increases are offset by the injuries typically sustained during the preseason. This suggests there may be front-loading of injuries over the course of an NFL season, such that players may be more prone to injury when the intensity of play suddenly increases, whether in the preseason or regular season.

Association of Limited In-Person Attendance in US National Football League and National Collegiate Athletic Association Games With County-Level COVID-19 Cases

In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level. To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties. In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020. Hosting NFL or NCAA games. The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance. A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from -5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period. This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.

Successful Outcomes and Return to Sport After Arthroscopic Bankart Repair in National Collegiate Athletic Association and National Football League Football Players.

To characterize recurrent instability, return to sport (RTS), and patient-reported outcomes (PROs) after arthroscopic Bankart repair for acute traumatic anterior shoulder instability in National Collegiate Athletic Association (NCAA) and National Football League (NFL) football players. Case series. Orthopaedic and sports medicine clinic. National Collegiate Athletic Association and NFL football athletes with traumatic anterior shoulder instability who underwent arthroscopic shoulder stabilization at a single institution with at least 2-year follow-up. Arthroscopic Bankart repair. Recurrent instability, RTS, patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Thirty-three players were included with a mean age of 23.8 years (range, 18-33 years) and a mean follow-up of 6.3 years (range, 4.1-9.3 years). One shoulder (3.0%) had a postoperative subluxation event, and 1 shoulder (3.0%) required revision surgery for issues other than instability; 93.3% of players were able to RTS at the same level or higher for at least 1 season. Mean satisfaction was 8.9 ± 2.3. Mean VAS was 1.0 ± 1.7, and mean ASES and Rowe scores were 90.7 ± 18.5 and 89.7 ± 15.2, respectively. Arthroscopic Bankart repair is an effective surgical intervention for traumatic anterior shoulder instability in NCAA and NFL football players. At a mean 6-year follow-up, surgery restored stability in 97% of cases and 93.3% returned to their preinjury level of sport.

NFL Football: A History of America's New National Pastime

The National Football League (NFL) seems nearly omnipresent today in the United States. Even people who are not football fans know the team names and recognize the star players. That was certainly not the case one hundred years ago when the league was founded at a car dealership in Canton, Ohio. How this change occurred is the story that Richard C. Crepeau tells in NFL Football: A History of America's New National Pastime. Originally published in 2014, the University of Illinois Press issued this revised edition in 2020 to coincide with the NFL's centennial. The author has expanded a couple of chapters from the previous edition and added a new chapter.The book is divided into three sections: “The Formative Years,” “The Rozelle Era,” and “The New NFL.” Within each section, chapters are often thematic, which occasionally means there is some repetitiveness. The first section examines the birth of professional American football in the 1890s and its slow growth through the early decades of the twentieth century. Initially centered in the factory and mill towns of the Ohio Valley, professional football developed as a game to entertain the working class on Sundays. By 1920, team owners decided to create an organization, the American Professional Football Association, the forerunner of the NFL. The league's first decade was rocky; few teams survived into the 1930s. (An excellent appendix lists all NFL franchises by the year they were founded, including those that folded.) Crepeau moves through the NFL's formative years quickly. The league's founding and first decade are covered in about thirteen pages. The author then summarizes the next decade and a half (1930‒45) in twelve pages. This is mostly a work of synthesis, so Crepeau cannot be blamed if the literature on early professional football and the first several decades of the NFL is thin. But readers hoping for more on the formative years will be disappointed.Crepeau begins to hit his stride by the third chapter, which examines the late 1940s and 1950s. In this chapter, some important themes emerge—the NFL as a business enterprise, the reoccurrence of labor disputes, race and racism in the league, and the role of television in shaping the sport. These themes are continued into Part 2, which looks at what Crepeau calls “The Rozelle Era.” This is the book's longest section, and it forms the core of the book. In this middle section, chapters follow a general chronology but are also organized thematically. Chapters 4 and 5 examine the rise of professional football as a major cultural phenomenon in the 1960s, as well as the NFL's dispute and eventual merger with the American Football League (AFL). Television, of course, played a major role in propelling professional football to the forefront of American culture. As Crepeau notes, “The landscape of the NFL changed permanently with the coming of television, the AFL, and the commodification of nearly everything” (61). Thanks to the game's seemingly made-for-television controlled violence and drama, Crepeau argues, by the end of the 1960s, “football was clearly the national pastime” (90). In Chapter 6, the author takes a deep dive into television contracts and the ever-increasing amounts of money that they brought to the league. After discussing expansion, battles over team moves, and the league's handling of various publicity problems (Commissioner Pete Rozelle's specialty) in Chapters 7 and 8, Crepeau turns to labor disputes in Chapter 9. His coverage of the formation and growth of the NFL Players Association (NFLPA), as well as the three major strikes of the 1970s and 1980s, is excellent and probably makes Chapter 9 the strongest one in the book.Section 3 begins with the rise of Paul Tagliabue as the new commissioner following Rozelle's retirement, and the subsequent chapters focus on Roger Goodell's tenure as commissioner. Although Crepeau does not ignore social and cultural issues in the book's concluding section, at times, it comes across as largely an institutional history of the league from 1990 to the present, with the commissioners—Tagliabue and then Goodell—as the central actors. The author devotes two pages, for instance, to Goodell's handling of Baltimore Ravens running back Ray Rice's assault of his fiancée in 2014; the emphasis is on Goodell, not on domestic violence. The final chapter examines the Super Bowl as America's gaudy new national holiday.Creapeau's book examines the NFL as a business and a cultural phenomenon. It succeeds on both accounts. Anyone looking for a short overview of the NFL's meteoric rise to America's national pastime should begin with Crepeau's book.

Retired National Football League Players are Not at Greater Risk for Suicide.

ObjectiveSome researchers have claimed that former National Football League (NFL) players are at increased risk for suicide as a clinical feature of chronic traumatic encephalopathy (CTE). This review examines the literature on risk for suicide in former professional football players, and the association between suicide and CTE.MethodA narrative review of the literature published between 1928 and 2018.ResultsBetween 1928 and 2009, suicide was not considered to be a clinical feature of CTE in the literature. The best available evidence from epidemiological studies suggests that former NFL football players are at lesser risk for suicide, not greater risk, compared to men in the general population. However, surveys have revealed that a substantial minority of former NFL players have depression and other mental health problems, chronic pain and opioid use is relatively common, and those with depression and chronic pain also have greater life stress and financial difficulties. That minority would be at increased risk for suicidal thoughts and behaviors.ConclusionsResearchers and clinicians are encouraged to be cautious and circumspect when considering the clinical presentation of former athletes, and to not assume that depression and suicidality are caused by specific types of neuropathology. This represents a reductionistic and Procrustean view. Some former football players have mental health problems, but it should not be assumed uncritically that the underlying cause is an inexorably progressive neurodegenerative disease. Providing evidence-informed and evidence-supported treatments for depression and suicidality might reduce suffering and improve their functioning.

The Gridiron and the Gray Flannel Suit: NFL Football and the Modern U.S. Workplace

Examining three critical periods of transformation in the history of professional football in the United States, this article demonstrates the centrality of the workplace to the development of the National Football League (NFL). The article argues that the NFL originated in the welfare capitalism of the early 1920s; that mass-mediated narratives about corporate management drove pro football’s coming-of-age in the 1950s and 1960s; and that fantasy football—the NFL’s most distinctive new form of spectatorship in the age of digital capitalism—positioned fans as imaginary managers of human capital. Taken together, these three pivotal moments demonstrate the inextricable links between changes in professional sports and transformations in the organization of work.

Association Between Playing American Football in the National Football League and Long-term Mortality

Studies of the longevity of professional American football players have demonstrated lower mortality relative to the general population but they may have been susceptible to selection bias. To examine the association between career participation in professional American football and mortality risk in retirement. Retrospective cohort study involving 3812 retired US National Football League (NFL) players who debuted in the NFL between 1982 and 1992, including regular NFL players (n = 2933) and NFL "replacement players" (n = 879) who were temporarily hired to play during a 3-game league-wide player strike in 1987. Follow-up ended on December 31, 2016. NFL participation as a career player or as a replacement player. The primary outcome was all-cause mortality by December 31, 2016. Cox proportional hazards models were estimated to compare the observed number of years from age 22 years until death (or censoring), adjusted for birth year, body mass index, height, and position played. Information on player death and cause of death was ascertained from a search of the National Death Index and web-based sources. Of the 3812 men included in this study (mean [SD] age at first NFL activity, 23.4 [1.5] years), there were 2933 career NFL players (median NFL tenure, 5 seasons [interquartile range {IQR}, 2-8]; median follow-up, 30 years [IQR, 27-33]) and 879 replacement players (median NFL tenure, 1 season [IQR, 1-1]; median follow-up, 31 years [IQR, 30-33]). At the end of follow-up, 144 NFL players (4.9%) and 37 replacement players (4.2%) were deceased (adjusted absolute risk difference, 1.0% [95% CI, -0.7% to 2.7%]; P = .25). The adjusted mortality hazard ratio for NFL players relative to replacements was 1.38 (95% CI, 0.95 to 1.99; P = .09). Among career NFL players, the most common causes of death were cardiometabolic disease (n = 51; 35.4%), transportation injuries (n = 20; 13.9%), unintentional injuries (n = 15; 10.4%), and neoplasms (n = 15; 10.4%). Among NFL replacement players, the leading causes of death were cardiometabolic diseases (n = 19; 51.4%), self-harm and interpersonal violence (n = 5; 13.5%), and neoplasms (n = 4; 10.8%). Among NFL football players who began their careers between 1982 and 1992, career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player during a league-wide strike, was not associated with a statistically significant difference in long-term all-cause mortality. Given the small number of events, analysis of longer periods of follow-up may be informative.

The Latarjet Procedure at the National Football League Scouting Combine: An Imaging and Outcome Analysis

Objectives:The Latarjet procedure is commonly implemented in the treatment of shoulder instability in the setting of glenoid bone loss, particularly in contact athletes such as American football players; however, little is known regarding the outcomes and failures rates of this procedure in collegiate football players prior to participating in the National Football League (NFL). The purposes of this study were to 1) determine the prevalence, clinical features, and imaging findings of National Collegiate Athletic Association (NCAA) football athletes who presented to the NFL scouting Combine having undergone the Latarjet procedure and 2) to evaluate the impact of this procedure, including imaging findings on these athletes’ performance as they entered the NFL.Methods:All NFL football players at the NFL Combine from 2009 to 2016 were reviewed. Inclusion criteria were any player who had a documented Latarjet procedure in the past and participated in medical and performance testing at the NFL Combine. Medical records, imaging, games and position played, and draft position of each player who had undergone a Latarjet procedure was then analyzed. In addition, radiographic features of each players with a Latarjet were evaluated including type of fixation, hardware complications, position of the bone block, degenerative changes, and healing/union/bony resorption were all assessed. NFL performance outcomes (draft position and number of games played and started within first two years) were assessed.Results:Of the 2285 players who participated in the NFL combine between 2009 and 2016, there were 13 athletes (0.6%) who had undergone a Latarjet procedure. Six patients had a two-screw fixation of the bone block while 7 had only one screw, with two patients evidencing a broken hardware (one with one screw and one with 2 screws) and two patients with bent screws (one with one screw and one with 2 screws). Screw prominence was observed in 1 patient. Eight of the 13 patients identified underwent computed tomography (CT) scans. All had evidence of bony resorption of the bone block on CT imaging. The majority of these (5) had evidence of minimal resorption (<25%). One had a moderate amount of resorption (<50%) and two others had almost resorption of the bone block.Conclusion:Only a small percentage of players at the NFL combine (0.6%) had undergone a Latarjet procedure in the past. Nevertheless, a high number of postoperative complications were observed including broken or bent screws and prominent hardware. Optimal graft positioning was observed in the majority of the patients. However, bone resorption was found in most of them.

Empirical Prediction of Turnovers in NFL Football.

Turnovers in the National Football League (NFL) occur whenever a team loses possession of the ball due to a fumble, or an interception. Turnovers disrupt momentum of the offensive team, and represent lost opportunities to advance downfield and score. Teams with a positive differential turnover margin in a given game win of the time. Turnovers are statistically rare events, occurring apparently randomly. These characteristics make them difficult to predict. This investigation advances the hypothesis that turnovers are predictable in NFL football. Machine learning models are developed to learn the concept: At any point within a football game, what is the likelihood that a turnover will be observed on the next play from scrimmage? NFL play-by-play data for 32 teams spanning seven full seasons were used to train the models. Results presented suggest evidence to support the working hypothesis. Under certain conditions, both fumbles and interceptions can be anticipated at low false discovery rates (less than ). When a turnover is predicted on the impending play from scrimmage, a high degree of confidence is associated with that prediction. The ability to anticipate catastrophic in-game events may lead to their management and control, ultimately improving the performance of individual athletes and their teams. This investigation contributes to the sports science literature by demonstrating the predictability of in-game events often considered to be essentially random in their occurrence. To the author’s knowledge, direct prediction of turnovers has not previously appeared in the literature, which has focused on retrospective statistical analyses of turnover margin in football games.

Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians.

Background:Although a recognized and discussed injury, chondral rib fractures in professional American football have not been previously reported in the literature. There currently exists no consensus on how to identify and treat these injuries or the expected return to play for the athlete.Purpose:To present 2 cases of chondral rib injuries in the National Football League (NFL) and discuss the current practice patterns for management of these injuries among the NFL team physicians.Study Design:Case series; Level of evidence, 4.Methods:Two cases of NFL players with chondral rib injuries are presented. A survey regarding work-up and treatment of these injuries was completed by team physicians at the 2014 NFL Combine. Our experience in identifying and treating these injuries is presented in conjunction with a survey of NFL team physicians’ experiences.Results:Two cases of rib chondral injuries were diagnosed by computed tomography (CT) and treated with rest and protective splinting. Return to play was 2 to 4 weeks. NFL Combine survey results show that NFL team physicians see a mean of 4 costal cartilage injuries per 5-year period, or approximately 1 case per year per team. Seventy percent of team physicians use CT scanning and 43% use magnetic resonance imaging for diagnosis of these injuries. An anesthetic block is used acutely in 57% and only electively in subsequent games by 39%.Conclusion:A high index of suspicion is necessary to diagnose chondral rib injuries in American football. CT scan is most commonly used to confirm diagnosis. Return to play can take up to 2 to 4 weeks with a protective device, although anesthetic blocks can be used to potentially expedite return.Clinical Relevance:Chondral rib injuries are common among NFL football players, while there is no literature to support proper diagnosis and treatment of these injuries or expected duration of recovery. These injuries are likely common in other contact sports and levels of competition as well. Our series combined with NFL team physician survey results can aid team physicians in identifying these injuries, obtaining useful imaging, and counseling players and coaches and the expected time of recovery.

A relationship between temperature and aggression in NFL football penalties

BackgroundIncreased ambient temperature has been implicated in increased physical aggression, which has important practical consequences. The present study investigates this established relationship between aggressive behavior and ambient temperature in the highly aggressive context of professional football in the National Football League (NFL). MethodsUsing a publicly available dataset, authors conducted multiple hierarchical regression analyses on game-level data (2326 games). ResultsThe analysis revealed that temperature positively predicted aggressive penalties in football, and that this relationship was significant for teams playing at home but not for visiting teams. ConclusionThese results indicate that even in the aggressive context of football, warmer weather contributes to increased violence. Further, the presence of the heat-aggression relationship for the home team suggests that the characteristics of interacting groups may influence whether heat would have an adverse effect on the outcome of those interactions.

Abdominal body composition differences in NFL football players.

The purpose of this study was to examine visceral fat mass as well as other measures abdominal body composition in National Football League (NFL) players before the start of the season. Three hundred and seventy NFL football players were measured before the start of the season using dual-energy x-ray absorptiometry. Regional fat and lean mass was measured for each player. Players were categorized into 3 groups based on positions that mirror each other: linemen; linebackers/tight ends/running backs and wide receivers/defensive backs. Significant differences were observed between the position groups for both lean and fat regional measurements. However, the magnitude of difference was much greater for fat measures than lean measures. Additionally, a threshold was observed (∼114 kg) at which there is a greater increase in fat accumulation than lean mass accumulation. The increase in fat accumulation is distributed to the abdominal region where thresholds were observed for subcutaneous abdominal fat accumulation (12.1% body fat) and visceral abdominal fat accumulation (20.1% body fat), which likely explains the regional fat differences between groups. The results of this study suggest that as players get larger, there is more total fat than total lean mass accumulation and more fat is distributed to the abdominal region. This is of importance as increased fat mass may be detrimental to performance at certain positions. The thresholds observed for increased abdominal fat accumulation should be monitored closely given recent research observed that abdominal obesity predicts lower extremity injury risk and visceral adipose tissue's established association with cardiometabolic risk.

Anterior Cruciate Ligament Reconstruction Practice Patterns by NFL and NCAA Football Team Physicians

This study aimed to determine practice patterns for National Football League (NFL) and National Collegiate Athletic Association (NCAA) Division I football team orthopaedic surgeons regarding management of anterior cruciate ligament (ACL) tears in elite, young, and middle-aged recreational athletes. Two hundred sixty-seven NFL and NCAA Division I team orthopaedic surgeons were surveyed through an online survey. A 9-question survey assessed surgeon experience, graft choice, femoral tunnel drilling access, number of graft bundles, and rehabilitation after ACL reconstruction. One hundred thirty-seven team orthopaedic surgeons (51%) responded (mean experience 16.75 ± 8.7 years). Surgeons performed 82 ± 50 ACL reconstructions in 2012. One hundred eighteen surgeons (86%) would use bone-patellar tendon-bone (BPTB) autografts to treat their starting running backs. Ninety (67%) surgeons drill the femoral tunnel through an accessory anteromedial portal (26% through a transtibial portal). Only 1 surgeon prefers a double-bundle to a single-bundle reconstruction. Seventy-seven (55.8%) surgeons recommend waiting at least 6 months before return to sport, whereas 17 (12.3%) wait at least 9 months. No surgeon recommends waiting 12 months or more before return to sport. Eighty-eight (64%) surgeons do not recommend a brace for their starting running backs during sport once they return to play. BPTB is the most frequently used graft for ACL reconstruction by NFL and NCAA Division I team physicians in their elite-level running backs. Nearly all surgeons always use a single-bundle technique, and most do not recommend a brace on return to sport in running backs. Return to sport most commonly occurs at least 6 months postoperatively, with some surgeons requiring a normal examination and normal return-to-sport testing (single leg hop).

Are Sleep Disturbances a Risk for Chronic Traumatic Encephalopathy? Only the Shadow Knows

J Seau, Ollie Matson, John Mackey. What do these individuals have in common? History of National Football League (NFL) stardom? Enshrinement or possible induction into the Pro Football Hall of Fame? Both are true. Yet all share something much more ominous. Death related to the sequelae of chronic traumatic encephalopathy.1 Chronic traumatic encephalopathy (CTE) is characterized by memory loss, depression, dementia and potentially premature death.2 In some individuals, such as Junior Seau—and more recently major league baseball player Ryan Freel—it has been posited as the cause of their suicide.3 Pathologic examination of the brain of those with CTE reveals a degenerative neurologic process which is now attributed to repetitive concussive brain trauma.4 With the revelation that some living former NFL stars such as Brett Favre and Tony Dorsett are having symptoms suggestive of CTE,5,6 there is growing concern about the safety of all sports that can result in concussive brain injury. This level of concern has caused the NFL and college football to change their rules regarding tackling, leading to penalties and possible ejection for tackles that target the head. The NFL in cooperation with the National Institutes of Health also has begun funding research in this area with most of the emphasis on early detection using brain imaging techniques and further studies of the neuropathology.7 However, is repetitive concussive injury the only risk factor for CTE? Could obstructive sleep apnea (OSA) and other sleep disturbances be contributing or exacerbating factors? Several recent studies document that many individuals who have suffered acute traumatic brain injury (TBI) are subsequently found to have a variety of sleep disturbances including OSA.8-10 In some of these studies, the prevalence of OSA and insomnia has been reported to be as high as 23% and 25% respectively.9,10 Furthermore, data suggest that cognitive function is worse in patients who have both OSA and previous TBI than in those with TBI alone.11 In addition, treatment for sleep disturbances in the setting of chronic TBI may improve cognition and mood.12 Studies of retired and active NFL football players have found that the prevalence of OSA ranges from 14% to 19%.13,14 However, the prevalence may be much higher in retired players.15 Awareness of the signifi cance of OSA prompted NFL Charities to fund the development of a short online screening application for all players although there has been little interest in teams to use it.16 In addition to their respective adverse effects on sleep, both OSA and insomnia have been linked to the development of mood disturbances including depression Are Sleep Disturbances a Risk for Chronic Traumatic Encephalopathy? Only the Shadow Knows