American football is the paradigm of contact sports; therefore, it is one of the high-performance activities in which players are at greater risk of injury. During the playoffs, the intensity, passion, and strength with which the players play each game increases, this undoubtedly represents a risk factor for injuries due to the powerful impacts.
Various epidemiological studies have shown that older players may be at greater risk of injury, while experienced teams and coaches can reduce this risk.
It is important to keep in mind that injuries can occur not only during matches but also during training days. The intensity of contact when tackling, blocking, and other physical interactions between players, as well as the speed at which they are played, are elements that can condition the development of severe injuries. The most frequent injuries among active football players are the following:
Knee injury: Cruciate ligament rupture, collateral ligament sprain, meniscus rupture. Injuries to the knees can be caused by strong blows, a fall or some sudden change in the direction that a player was running. The knees are the area with the highest number of injuries among NFL players.
Ankle injury: Sprained ankle. At the same injuries in the knees, ankles suffer much from the strong impact and falls.
Injuries to the legs in general, thigh or ankle: tendon deformation, sprains. These injuries are the product of heavy blows and the enormous wear to which they are subjected during the season, adverse weather conditions also favor this type of injury.
Tendon injury: tears and ruptures, are usually the result of poor warming or muscle overexertion
Shoulder injury: Dislocated shoulder, joint injury. Any player can suffer a shoulder injury, but the QB has the highest risk of problems in this joint. This is due to the wear and tear that occurs in this joint when launching the football.
Head injury: Contusion. Brain contusions are some of the most feared injuries due to their clinical implications both in the short and long term. These injuries usually happen when helmet-helmet or helmet-field shock occurs. The NFL has implemented measures so that a player after suffering this type of injury leaves the game to be evaluated immediately by a medical team.
When highly competitive athletes suffer some type of injury, surgery is usually used to ensure adequate and prompt healing of the injured tissues. An overview of some injuries suffered in the past by top NFL players is provided below.
Notable Player Injuries and Their Recovery Process
Adrian Peterson, ruptured anterior cruciate ligament (ACL)
In December 2011 the stellar runner Minnesota Vikings Adrian Peterson suffered a torn anterior cruciate ligament after receiving a direct hit on his knee by safety Redskins DeJon Gomes. The injury was diagnosed after the game by MRI.
The ligaments are cords of connective tissue that join the bones that make up a joint. The anterior cruciate ligament, one of the two ligaments that cross the middle of the knee, connects the femur with the tibia and helps stabilize the knee joint.
In 2012 Peterson underwent surgery for reconstruction of the broken anterior cruciate ligament. During surgery, the broken ligament is removed and replaced with a graft. Autografts are usually performed in which the patellar tendon, quadriceps tendon or hamstring tendon of the same patient is used. Another option is the allograft, in which the tissue of a deceased donor is used.
The surgery is usually performed by arthroscopy, in which small incisions are made in the knee through which the surgeon inserts the arthroscope. A camera at the end of the arthroscope transmits live images from inside the knee to a screen in the operating room, this allows a better visualization of the structures and precision during surgery. Subsequently, the surgeon performs perforations or tunnels in the femur and tibia to place the graft, which is then secured to the bones with screws or other fixation devices. The graft will serve as a scaffold on which new ligament tissue can grow.
If an autograft is used, the surgeon will make another incision in the knee and take the replacement tissue. Finally, the small incisions made are closed by stitches.
Early mobilization after surgery is recommended to strengthen the ligament and prevent fibrosis. Physical therapy is essential for the full recovery of the joint functionality.
Marcus Mariota, ankle fracture
In December 2016, the Tennessee Titans quarterback, Marcus Mariota, suffered a fracture of the right fibula after being captured by Jaguars defensive tackle Sheldon Day.
The ankle is a complex joint that is composed of 3 bones, the internal part is made up of the tibia (tibial malleolus), the external part by the fibula (peroneal malleolus), and the lower part by the talus. Ankle fractures are usually caused by two mechanisms, twisting or direct impact on the ankle.
The goal of surgery is to reduce the fracture and reconstitute the anatomical structure of the joint to preserve its functionality. If the shape and anatomy of the ankle are not restored correctly, wear of the cartilage that lines the joint occurs, which inevitably leads to osteoarthritis.
During the surgery, an incision is made on the ankle to access the focus of the fracture. Once the broken bone fragments have been identified, they are placed in their anatomy position (open reduction) and fixed using metal plates and / or screws (internal fixation). This fixation provides stability so that movement can begin shortly after surgery.
Eric Berry, Achilles tendon rupture
In September 2017, the safety of the Kansas City Chiefs, Eric Berry, suffered a rupture of the Achilles tendon and therefore underwent surgery for repair.
The Achilles tendon joins the calf muscles to the calcaneus bone and its main function is the elevation of the heel of the foot from the ground. It is the thickest and strongest tendon in the body and is inserted into the calcaneus bone. It is usually broken 2 or 3 centimeters above the insertion due to the poor vascularization that it has in this area.
A total rupture of the Achilles tendon will require surgical treatment while in a partial rupture of the Achilles tendon may not need surgical repair and the use of a cast should be weighed for 3 to 6 weeks in order to regenerate the tendon. The advantage of surgical treatment is the low incidence of recurrence of tendon rupture, while the disadvantage is the postoperative complications of any surgical wound.
During the surgery, an incision approximately 8 centimeters in length is made from the calf to the ankle. The anatomical planes are separated until the two ends of the torn Achilles tendon are reached. After suturing the Achilles tendon, the plantar muscle tendon is used to reinforce the two ends of the repaired tendon. Another common repair implements the use of suture anchors which would secure the superior (upper) section of the tendon to the calcaneus (heel) bone.
It is important to protect the reconstructed Achilles tendon by its own physiological envelope (fascia) or with the help of a special dressing that prevents the adhesions of the Achilles tendon to the skin. Finally, the anatomical planes of the skin are sutured.
It is common to use a drain for 1 or 2 days to avoid the accumulation of blood remains in the wound since these can cause complications in good tissue healing.
The postoperative period requires the use of walking crutches since the leg operated on the floor cannot be supported.
The angle between the foot and leg is maintained at 90º by means of a plaster splint in order to avoid ankle stiffness during the first two weeks.
Darrius Guice, meniscus tear
In September 2019, Washington Redskins runner Darrius Guice suffered a meniscus tear at the conclusion of a 23-yard run, Packers safety Darnell Savage hit him in the legs while the runner fell at the floor.
The menisci are cartilaginous structures that are part of the knee joint and whose function is to increase the articular surface, which allows a more homogeneous distribution of the weight load between the femur and the tibia. In addition, the menisci provide stability to the knee, improve its functionality and, thanks to its padding, provide better shock absorption and a consequent reduction of cartilage wear that covers the bones that form the knee.
Currently, the treatment of this injury is usually performed by arthroscopy since it is a minimally invasive surgery that allows meniscus repair without opening the knee, thus reducing hospitalization and recovery times.
During the procedure, the surgeon inserts the arthroscope through a small incision near the knee to visualize the structures of the joint and repair the injured meniscus by suturing or anchoring. Surgical instruments can be inserted through other small incisions.
Drew Brees, finger surgery
In September 2019, the New Orleans Saints quarterback, Drew Brees, suffered a broken ligament when he hit the hand of Aaron Donald, the Los Angeles defensive tackle.
After carrying out the corresponding imaging studies, it was evident that Drew Brees had suffered a rupture of the ulnar collateral ligament, which stabilizes the thumb joint and plays a fundamental role in the functions of said joint, whose main action is to perform the clamp.
During the surgery, a longitudinal incision is made on the ulnar (external) area of the thumb joint to expose the injured ligament. Subsequently, a perforation is performed in the reinsertion zone where an intraosseous anchor is placed to which the ligament is fixed by resorbable sutures. Subsequently, the hand is immobilized for 3 weeks and then physiotherapy begins with flex-extension movement.
Matt Kalil, hip tear
In September 2016, the left tackle of the Minnesota Vikings, Matt Kalil, underwent surgery to repair a tear hip suffered during a regular-season game.
The hip is a joint composed of a sphere-like articular surface and a cavity. The edge of the cavity is covered with a ring of cartilage called the labrum. This protects the bone and helps isolate the joint. The tearing of this cartilage causes irritation of the hip, pain, and limitation of movement.
The only way to cure a tear hip is through a type of surgery called hip arthroscopy. During surgery, the doctor makes small incisions called portals, through which the surgeon inserts the arthroscope to clearly visualize the joint.
Labrum tears can be removed or repaired. The torn labrum segment can be removed by trimming or by ablation (heating the tissue to remove it). The repair of the torn labrum is carried out by suturing the tear to the bone. In this case, an anchor point is placed in the bone to tie the labrum to that point with suture thread. Once the surgeon finishes the procedure, the portals (incisions) are closed and covered with a bandage. A few weeks after surgery, physiotherapy should be performed to speed up the recovery process.
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