The Epidemiology of Injuries Identified at the National Football League Scouting Combine and their Impact on Professional Sport Performance: 2203 athletes, 2009-2015

Objectives: Normal At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the Combine and their impact on NFL performance. The purpose of this study is to determine the epidemiology of injuries identified at the Combine and their impact on future NFL performance. Methods: All previous musculoskeletal injuries identified at the NFL combine (2009-2015) were retrospectively reviewed. Medical records and imaging reports were examined. Game statistics for the first two seasons of NFL play were obtained for all players from 2009 to 2013. Analysis of injury prevalence and overall impact on draft status and position-specific performance metrics of each injury was performed and compared versus a position-matched control group with no history of injury and surgery. Results: A total of 2,203 athletes over seven years were evaluated, including 1,490 (67.6%) drafted athletes and 1,040 (47.2%) who ultimately played at least two years in the NFL. The most common sites of injury were the ankle (1160, 52.7%), shoulder (1143, 51.9%), knee (1128, 51.2%), spine (785, 35.6%), and hand (739, 33.5%). Odds ratios (OR) demonstrated quarterbacks were most at risk of shoulder injury (OR 2.78, p=0.001) while running backs most commonly sustained ankle (OR 1.49, p=0.038) and shoulder injuries (OR 1.55, p=0.022). Ultimately, defensive players demonstrated a more negative impact than offensive players following injury with multiple performance metrics impacted for each defensive position analyzed whereas skilled offensive players (i.e. quarterbacks, running backs) demonstrated only one metric affected at each position. Conclusion: The most common sites of injury identified at the Combine were: (1) ankle, (2) shoulder, (3) knee, (4) spine, and (5) hand. Overall, performance in the NFL was significantly impacted by previous injuries. NFL performance was directly dependent on position played as well as anatomic location of injury. Defensive players were more negatively impacted than offensive players. Additional work is necessary to determine longer-term impact of these injuries on NFL career and post-NFL quality of life.