Anterior Cruciate Ligament Injuries in National Football League Players from 2012 to 2022: A Descriptive Epidemiology Study.

Abstract

There is a high incidence of anterior cruciate ligament (ACL) tears in National Football League (NFL) players. There is a relative paucity of long-term data characterizing the effects of artificial versus natural playing surfaces on ACL tear incidence. A comprehensive search of publicly available data identified any NFL player who sustained an ACL injury from 2012 to 2022. The publicly available databases allowed for characterization of playing surface, player position, timing of injury in season, mechanism of injury, and player age. Incidence of ACL injuries by playing surface, player position, and position group relative to all other positions or position groups were compared by chi squared test. Correlates of in-game ACL injury were determined by stepwise multivariate logistic regression. There were 520 NFL players who experienced an ACL tear between seasons 2012-13 and 2022-23. There was no significant difference in incidence of ACL tears on artificial turf versus natural playing surfaces (265 versus 255, p=0.670). Wide receivers (p=0.027) were associated with a significantly higher incidence of ACL tears compared to other positions. Receivers (wide receivers and tight ends) (p=0.007) were associated with significantly higher incidence of ACL tears compared to other position groups, while specialists (punters, kickers, and long snappers) (p<0.001) were associated with significantly lower incidence of ACL tears compared to other position groups. No significant difference between mechanism of injury between playing surfaces was found (p=0.765). More ACL tears occurred before week 9 than on or after week 9 in-season, and the proportion of ACL tears occurring during a game (67%) was significantly higher than those occurring during practice. There was no statistically significant difference in incidence of ACL tears in NFL players from the 2012-13 to 2022-23 seasons based on playing surface (artificial versus natural). Wide receivers had a significantly higher incidence of ACL tears compared to other positions and tears were more common during games and before week 9 in-season.