Meniscectomy More Detrimental Than ACL Reconstruction to Pro Football Players' Career Length

Nancy A. Melville

July 16, 2009

July 16, 2009 (Keystone, Colorado) — Meniscus surgery might offer a shorter recovery time than anterior cruciate ligament (ACL) reconstruction for knee injuries, but it might be more detrimental to a professional football players' career, according to a study presented here at the American Orthopaedic Society for Sports Medicine 35th Annual Meeting.

Meniscectomy and ACL reconstruction are both common surgeries among college football players, but there is scant published evidence on the impact that the respective injuries have on players' careers. In an effort to find out how the surgeries compare, the investigators tested how histories of the injuries among athletes related to career longevity in the National Football League (NFL), compared with control subjects who had not had the surgeries.

The study evaluated the injury history and career statistics for NFL players who entered the league from 1987 to 2000, matching athletes with a history of meniscectomy and/or ACL surgery and no other surgery or major injury to a control group of athletes with no previous injuries.

Players were also matched according to position, year drafted, round drafted, and additional history.

"We had well-matched controls," said lead author Robert H. Brophy, MD, assistant professor in the Department of Orthopaedic Surgery at the Washington University School of Medicine and assistant team physician for the St. Louis Rams.

"Thirty-two were drafted in the same year and same round. Fifty-seven were within plus-or-minus 1 year and/or round, and only 5 were within plus-or-minus 2 years and/or rounds," he said.

Fifty-four of the athletes had a history of meniscectomy, 29 had a history of ACL reconstruction, and 11 had a history of both.

Compared with controls who had no surgeries, players with isolated meniscectomy had careers that were approximately 1.5 years shorter (5.6 years vs 7.0 years; P = .03), and the athletes played 23 fewer games (62 vs. 85; P = .02).

Athletes with isolated ACL surgery, however, had no reduction in length of career or games played, compared with noninjured controls.

Athletes who had undergone both ACL and meniscectomy surgeries had careers that were shortened by an average of nearly 2 years (4.0 vs 6.1) and 32 games (41 vs 73), but with a relatively small sample of 11 athletes, the difference from controls who had no surgeries was not considered to be significant.

Compared with athletes who had either isolated meniscectomy or ACL reconstruction, however, the athletes who had both surgeries started fewer games in their careers (7.9 vs 35.1; P < .01), played fewer games (41 vs 63; P = 0.07), and spent fewer years in the league (4.0 vs 5.8; P = .08).

The study concluded that a history of ACL reconstruction appears to have minimal effect on the length of a professional football player's career, whereas meniscectomy can shorten the expected career, and a history of an ACL reconstruction and meniscectomy might have a more adverse effect on a player's career than either of the surgeries in isolation.

There were limitations to the study. “The data were [prospectively] collected to evaluate the athletes and then reviewed. Technically, this is a retrospective review of prospective data,” Dr. Brophy told Medscape Orthopaedics. He also noted that the study lacks data on the status of articular cartilage and the site of the lesion in meniscus, although the database did include information on anyone who had a known cartilage lesion, and those athletes were excluded.

Other limitations included the small sample size for the combined cohort, and the fact that there were no meniscal repairs.

The study was nevertheless well matched and well controlled, Dr. Brophy said, adding that the findings offer important insight into the impact of meniscectomy and ACL reconstruction on an athlete's career.

"Meniscectomy is the most common surgical procedure performed on American football athletes," he explained. "The morbidity of meniscectomy may be related to increased body weight in athletes, as well as the high loads on the knee in professional football, and the functional demand in professional football may hasten degenerative change in the postmeniscectomy knee."

"Meanwhile, successful ACL reconstruction enables athletes to have similar-length careers as their noninjured counterparts."

The findings might come as a surprise to many involved in professional football, where it is commonly assumed that ACL surgery can indeed have a detrimental effect on a player's career, said Kurt P. Spindler, MD, a professor of orthopaedics and director of sports medicine at Vanderbilt University in Nashville, Tennessee.

"Everyone expects that when someone tears their ACL, they [will] have their career shortened because it's a bad injury," he said. "But I think it's very surprising that having an isolated meniscectomy at that level of competition really appears to be worse than having an isolated ACL reconstruction."

Dr. Spindler, who was not involved in the study, said the findings will likely translate to other professional-level sports. "I think other elite athletes at the competition level may, indeed, be in a similar situation."

"The value of the study is to show that if you have these injuries, even with the gold standard of treatment, the type of injury does make a difference from a player and a team's point of view," he said. "Having a meniscus surgery by itself is going to be problematic."

Dr. Brophy's study did not receive commercial support. Dr. Brophy disclosed that he is a consultant with Depuy Orthopedics Inc. Dr. Spindler disclosed that he is the medical director of NFL Charities, which provides medical research grants.

American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting: Abstract 8346. Presented July 11, 2009.

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