Evolving Treatment Patterns of NFL Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016

BACKGROUND: Previous studies have analyzed the treatment patterns used to manage injuries in National Football League (NFL) players. HYPOTHESIS: Treatment patterns for injuries in NFL players will have changed over the study period. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 5. METHODS: The head orthopaedic team physicians for all 32 NFL teams were asked to complete a survey containing questions regarding experience as team physician, medical coverage of the team, and treatment preferences for some of the most common injuries occurring in football players. Responses from the current survey were compared with responses from the same survey sent to NFL team physicians in 2008. RESULTS: Responses were received from 31 (31/32, 97%) NFL team physicians in 2008 and 29 (29/32, 91%) NFL team physicians between April 2016 and May 2017. The proportion of physicians preferring patellar tendon autograft in anterior cruciate ligament (ACL) reconstruction increased from 87% in 2008 to 97% in 2016 (P = 0.054). In 2008, 49% of physicians allowed return to contact after ACL reconstruction at 6 months or less as compared with only 14% of physicians in 2016 (P = 0.033). In 2008, 93% of physicians used Toradol injections prior to a game to help with nagging injuries. Toradol injection utilization decreased to 48% of physicians in 2016 (P < 0.001). Seventy-nine percent of physicians would administer 5 or more Toradol injections prior to a game in 2008, as compared with 28% of physicians in 2016 (P < 0.0001). CONCLUSION: Orthopaedic physicians have changed their injury treatment preferences for professional football players. In particular, physicians have become more cautious with allowing players to return to play after ACL reconstruction and with the use of pregame Toradol injections. CLINICAL RELEVANCE: Expert opinions can help guide treatment decisions and lead to better care of all athletes.