Shoulder Surgery May Extend NFL Careers

While shoulder instability can be successfully treated both surgically and nonoperatively, a new study finds that surgical fixation leads to less risk of re-injury and greater career longevity among National Football League (NFL) athletes.

About 10% to 14% of NFL players experience shoulder instability at some point. The study, “Career Longevity and Performance After Shoulder Instability in National Football League Athletes,” published in the May 2021 issue of the journal Arthroscopy, sought to analyze career longevity, game utilization and performance between NFL players who had glenohumeral instability treated operatively and those who were treated nonoperatively.

“When one is managing the care of professional football players, it is paramount to recognize that successful return to play does not necessarily equate to satisfactory outcomes. Glenohumeral dislocation and subluxation injuries can be extremely detrimental for NFL athletes because the routine performance of football-specific tasks, such as overhead throwing, blocking and/or pushing opposing players, or bracing during a fall to the ground can increase the risk of recurrent instability,” the researchers wrote.

Ninety-seven players who were injured between September 2000 and February 2019 were included in the study. Ninety-one or 93.8% returned to play.

The quarterbacks were more likely to undergo immediate surgery for the instability compared with other players (p = .023), the data shows.

The final analysis included 58 players who underwent surgery and 33 who had their injury managed nonoperatively.

Overall, players treated operatively played more after returning to the game (4.1 ± 2.7 seasons vs. 2.8 ±2.5 seasons, p = .015). There however was no difference in games played or started, offensive or defensive snap count percentage, or performance before or after the injury between the two groups (p > .05).

Time to return to play was longer after surgery than nonoperative management (36.62 ± 10.32 weeks vs. 5.43 ± 12.33 weeks, p < .05), but with surgery there was also a longer time interval before recurrent instability (105.7 ± 100.1 weeks vs. 24.7 ± 40.6 weeks, p < .001).

The players who had surgery also experienced less re-injury (27% vs. 50%, p = .035).

“Athletes who return to play 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 return to play, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevity.”