Effect of COVID-19 on Injury Rates and Timing in the National Football League

Ali M Omari; Ryan W Paul; Brian Fliegel; Alim Osman; Meghan E Bishop; Brandon J Erickson; Frank G Alberta

doi:10.1177/23259671221098749

Effect of COVID-19 on Injury Rates and Timing in the National Football League

Orthop J Sports Med. 2022 Jun 2;10(6):23259671221098749. doi: 10.1177/23259671221098749. eCollection 2022 Jun.

Authors

Ali M Omari^{1

2}, Ryan W Paul¹, Brian Fliegel³, Alim Osman⁴, Meghan E Bishop¹, Brandon J Erickson¹, Frank G Alberta^{1

5

6}

Affiliations

¹ Rothman Orthopaedic Institute, New York, New York, USA.
² Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan, USA.
³ Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA.
⁴ Eastern Virginia Medical School, Norfolk, Virginia, USA.
⁵ Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
⁶ Hackensack University Medical Center, Hackensack, New Jersey, USA.

Abstract

Background: The coronavirus 2019 (COVID-19) pandemic resulted in the cancellation of the 2020 National Football League (NFL) preseason and a decreased preseason roster size. The effect of this disruption on athlete injury rates is unknown.

Purpose/hypothesis: The purpose was to quantify the rates of anterior cruciate ligament (ACL), Achilles tendon, and hamstring tendon injuries in NFL players before and after the COVID-19 pandemic. We hypothesized that injury rates in the 2020 season would be higher than those seen prepandemic.

Study design: Descriptive epidemiology study. Level of evidence, 4.

Methods: An online search using publicly available data was carried out to identify all NFL players who sustained an ACL, Achilles tendon, or hamstring tendon injury between April 1, 2017, and March 31, 2021. Data collected included player characteristics as well as career and season of injury workloads.

Results: The number of Achilles tendon (27 vs 20; P = .024) and hamstring tendon (186 vs 149; P < .001) injuries, respectively, in the 2020 NFL season were significantly higher than the average of the 2017 to 2019 seasons. However, the number of ACL injuries sustained remained constant (43 vs 46; P = .175). More than half (52.9%) of ACL injuries in the 2017 to 2019 seasons occurred in the preseason, while most of the injuries (34.9%) in the 2020 season occurred in weeks 1 to 4. There was no player characteristic or career workload variable collected that was significantly different for players who sustained an ACL, Achilles tendon, or hamstring tendon injury in the 2020 NFL season compared with the 2017 to 2019 seasons.

Conclusion: In the 2020 NFL season, the number of Achilles tendon and hamstring tendon injuries rose while the number of ACL injuries remained constant compared with the 2017 to 2019 seasons. Injuries that occurred during the first 4 games of the 2020 NFL season were consistent, with higher rates of injuries seen in the preseason in previous years.

Keywords: ACL; Achilles; COVID-19; NFL; National Football League; anterior cruciate ligament; hamstring; injury; pandemic.