Career Longevity and Performance Following Shoulder Instability in National Football League Athletes

Purpose: To investigate the career longevity, game utilization and performance of National Football League (NFL) athletes following glenohumeral instability events treated operatively versus nonoperatively. Methods: Public resources identified NFL players who sustained a shoulder instability event from 2000-2019. Players with prior shoulder instability, without NFL experience before injury, or who did not return to play (RTP) after injury were excluded. Demographic information, utilization (games and seasons), and season approximate value (SAV) statistics were recorded one year prior to injury and three years following return to play (RTP). Statistical analysis compared utilization and SAV following RTP for athletes managed operatively versus nonoperatively. Results: Ninety-seven NFL players who sustained their first instability event while playing in the NFL were identified, 91 of whom RTP (93.8%). Quarterbacks were significantly more likely to undergo immediate surgical management compared to other positions (P=.023). Final analysis included 58 players managed operatively and 33 players managed nonoperatively by the end of the index season. Players treated operatively played in significantly more seasons following RTP during their remaining career (4.1±2.7 vs. 2.8±2.5 seasons; P=.015). There were no differences in games played or started, offensive or defensive snap count percentage, or performance (SAV) before and after injury when compared between cohorts (P\u3e.05). Following surgical stabilization, time to RTP (36.62±10.32 vs. 5.43±12.33 weeks, P Conclusions: Athletes who RTP in the NFL following a shoulder instability injury do so with similar workload and performance irrespective of surgical or non-surgical management. While nonoperative treatment is associated with faster return to play, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevit

Career Longevity and Performance After Shoulder Instability in National Football League Athletes

PURPOSE: To investigate the career longevity, game utilization, and performance of National Football League (NFL) athletes after glenohumeral instability events treated operatively versus nonoperatively. METHODS: Using public resources, we identified NFL players who sustained a shoulder instability event from September 2000 to February 2019. Players with prior shoulder instability, without NFL experience before injury, or who did not return to play (RTP) after injury were excluded. Demographic information, utilization (games and seasons), and season approximate value (SAV) statistics were recorded 1 year prior to injury and 3 years after RTP. Statistical analysis compared utilization and the SAV after RTP for athletes managed operatively versus nonoperatively. RESULTS: We identified 97 NFL players who sustained their first instability event while playing in the NFL, 91 of whom returned to play (93.8%). Quarterbacks were significantly more likely to undergo immediate surgical management compared with players in other positions (P = .023). The final analysis included 58 players managed operatively and 33 managed nonoperatively by the end of the index season. Players treated operatively played in significantly more seasons after RTP during their remaining careers (4.1 ± 2.7 seasons vs 2.8 ± 2.5 seasons, P = .015). There were no differences in games played or started, offensive or defensive snap count percentage, or performance (SAV) before and after injury when compared between cohorts (P \u3e .05). After surgical stabilization, time to RTP (36.62 ± 10.32 weeks vs 5.43 ± 12.33 weeks, P \u3c .05) and time interval before recurrent instability (105.7 ± 100.1 weeks vs 24.7 ± 40.6 weeks, P \u3c .001) were significantly longer than with nonoperative treatment. Additionally, the operative cohort experienced less recurrent instability (27% vs 50%, P = .035). CONCLUSIONS: Athletes who RTP in the NFL after a shoulder instability injury do so with a similar workload and performance irrespective of surgical or nonsurgical management. Whereas nonoperative treatment is associated with faster RTP, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevity. LEVEL OF EVIDENCE: Level III, retrospective case-control study