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J Knee Surg
DOI: 10.1055/a-2652-2567
Original Article

Anterior Cruciate Ligament Injuries in National Football League Players from 2012 to 2022: A Descriptive Epidemiology Study

Ashwin R. Garlapaty
1   University of Missouri School of Medicine, Columbia, Missouri
,
Rown Parola
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Morgan C. Kluge
1   University of Missouri School of Medicine, Columbia, Missouri
,
Quin P. Blankenship
1   University of Missouri School of Medicine, Columbia, Missouri
,
Abdoulie Njai
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
James T. Stannard 
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Caleb J. Bischoff
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
James L. Cook
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Steven F. DeFroda
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Clayton W. Nuelle 
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
› Author Affiliations
Funding None.
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Abstract

There is a high incidence of anterior cruciate ligament (ACL) tears in National Football League (NFL) players. There is a relative paucity of long-term data characterizing the effects of artificial versus natural playing surfaces on ACL tear incidence. A comprehensive search of publicly available data identified any NFL player who sustained an ACL injury from 2012 to 2022. The publicly available databases allowed for characterization of playing surface, player position, timing of injury in season, mechanism of injury, and player's age. Incidence of ACL injuries by playing surface, player position, and position group relative to all other positions or position groups were compared by chi-squared test. Correlates of in-game ACL injury were determined by stepwise multivariate logistic regression. There were 520 NFL players who experienced an ACL tear between seasons 2012–2013 and 2022–2023. There was no significant difference in incidence of ACL tears on artificial turf versus natural playing surfaces (265 versus 255, p = 0.670). Wide receivers (p = 0.027) were associated with a significantly higher incidence of ACL tears compared with other positions. Receivers (wide receivers and tight ends) (p = 0.007) were associated with significantly higher incidence of ACL tears compared with other position groups, while specialists (punters, kickers, and long snappers) (p < 0.001) were associated with significantly lower incidence of ACL tears compared with other position groups. No significant difference between mechanism of injury between playing surfaces was found (p = 0.765). More ACL tears occurred before week 9 than on or after week 9 in-season, and the proportion of ACL tears occurring during a game (67%) was significantly higher than those occurring during practice. There was no statistically significant difference in incidence of ACL tears in NFL players from the 2012–2013 to 2022–2023 seasons based on playing surface (artificial versus natural). Wide receivers had a significantly higher incidence of ACL tears compared with other positions and tears were more common during games and before week 9 in-season.

Keywords

anterior cruciate ligament - National Football League - natural grass - artificial turf - knee injury

Ethical Statement

This study was exempt from review by University of Missouri's Internal Review Board.




Publication History

Received: 30 June 2025

Accepted: 09 July 2025

Accepted Manuscript online:
10 July 2025

Article published online:
23 July 2025

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