Sports Medicine: Just the Facts

CHAPTER 83 • FOOTBALL 491

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83 FOOTBALL

John M MacKnight, MD

INTRODUCTION

• Sports medicine coverage of American football places
  unique demands on the sports medicine practitioner. A
  wide variety of sport-specific conditions and injuries
  demand that individuals responsible for the care of
  football teams be well versed in an array of both med-
  ical and orthopedic issues. Appropriate planning can
  minimize the likelihood of athlete injury and help to
  ensure that athletes are protected and returned to play
  as quickly as possible.

MUSCULOSKELETAL INJURIES

• Fifty percent of football players at all levels will be
  injured to some degree in any given season. The
  majority of these injuries involve the lower extremity
  with sprains, contusions, and strains being most
  common. Fractures account for 10% of injuries.

LOWER EXTREMITY INJURIES

MEDIALCOLLATERALLIGAMENTSPRAIN, KNEE

• The most common knee injury seen in football, result-
  ing from a valgus load to the knee by another player
  during blocking or tackling.


• Grade-I injuries have stretched but not disrupted the
  ligament and the knee examination (valgus loading of
  the knee at 0°and 30°of flexion) reveals no laxity
  compared to the uninjured side. Grade-II injuries have
  partial ligament disruption with discernible laxity on
  valgus testing but preservation of an end point. Grade-
  III injuries represent full ligament tears with gross
  laxity and no discernible end point.


• All three grades are generally managed conservatively
  with icing, nonsteroidal anti-inflammatory drugs
  (NSAIDs), and protective bracing. Even athletes with
  grade-III injuries may resume sport in protective
  braces if symptoms allow.


• Many football programs now utilize protective medial
  stabilizing braces to decrease the incidence of medial
  collateral ligament(MCL) injury, particularly in inte-
  rior linemen. Although data have not clearly proven
  their efficacy, they may enhance proprioceptive func-
  tion and are a reasonable preventative measure for at-
  risk players.

ANTERIORCRUCIATELIGAMENTTEAR

• The most devastating knee injury commonly seen in
  football. Anterior cruciate ligament(ACL) tears gen-
  erally result from valgus loading of the slightly flexed
  knee creating significant shear forces on the ACL and
  subsequent tearing. The majority are noncontact
  injuries, but the ACL may be torn in a similar contact
  mechanism to that of the MCL noted above.


• The injury is accompanied by significant pain, imme-
  diate swelling, subjective instability of the knee, often
  an audible “pop” or a sense of tearing inside the knee,
  and laxity on the Lachman test.
  •For competitive athletes, ACL tears will generally
  require surgical reconstruction. Graft options include
  patellar tendon, hamstring tendon, or cadaveric grafts.
  Patellar tendon grafts are generally preferred in ath-
  letes but may lead to earlier patellofemoral arthritis
  than the alternatives. Caution must also be used with