title: Whole-Person Impairment in Younger Retired NFL Players: The Orthopaedic Toll of a Professional Football Career.
abstract: BACKGROUND
  Professional American football is a physically demanding, high-impact sport with an elevated risk of injury. Orthopaedic injuries may impose acute, short-term or cumulative consequences throughout a player's lifetime. Several studies have addressed health and psychosocial concerns of an older, retired population of players in the National Football League (NFL); however, minimal research has examined the orthopaedic toll on younger, retired players.
  
  
  OBJECTIVE
  This study reports total whole-person impairment (WPI) percentages in a cohort of younger, retired NFL players who presented for disability evaluations based on the use of standardized American Medical Association (AMA) impairment guidelines.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  During the study period of February 2011 to August 2013, 65 younger retired NFL players presented for impairment evaluations. The mean time between retirement and impairment evaluation was 3.1 years (range, 0.3-16.4 years). A complete history and physical examination was performed on all symptomatic joints. A retrospective chart review was conducted on 100% of presenting players to assess orthopaedic burden. Body-part impairment (BPI) percentage for each affected joint was generated. The impairment data for each extremity were then combined with spine impairment data to create WPI percentage. Player demographics, including age, position, and playing time, were also recorded.
  
  
  RESULTS
  The average WPI percentage was 37% (range, 19%-53%). Players participating in >30 games (n = 54) had a higher mean WPI percentage (38%) than those playing in <30 games (31%; n = 11) (P = .004). Players competing in >5 seasons (n = 46) were 2.4 times more likely to have a WPI of at least 37% (P = .007). The most common joints players reported as symptomatic were lumbar (n = 63; 97%) and cervical spine (n = 58; 89%). The mean age at evaluation was 33.5 years (range, 27-42 years), and the mean number of seasons played was 7.5 (range, 3-14 seasons). The mean number of games played was 98.4 (range, 2-236 games).
  
  
  CONCLUSIONS
  This study demonstrated high WPI percentages related to symptomatic joints in a cohort of younger, retired NFL players. Further research is warranted to study potential cumulative physical and quality of life factors related to high impairment percentages in younger, retired NFL players.
authors.affiliation: American Hip Institute in Chicago, Westmont, Illinois, USA. ; Hinsdale Orthopaedics, Westmont, Illinois, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Domb
authors.affiliation: Advanced Physicians, Crest Hill, Illinois, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Carter
authors.affiliation: American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Finch
authors.affiliation: American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Hammarstedt
authors.affiliation: American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Dunne
authors.affiliation: American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Stake
keywords: National Football League; disability; football; impairment; orthopaedic; retired