Return to Play in National Football League Players After Operative Jones Fracture Treatment

Abstract

Background: Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. The purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. Operative treatment for the majority of patients involved fixation with a Jones-specific intramedullary screw and iliac crest bone marrow aspirate with demineralized bone matrix injected at the fracture site. Additionally, our protocol involved the use of noninvasive bone stimulators, application of customized orthoses, and an aggressive patient-specific rehabilitation protocol. Patient demographics were recorded along with position played, seasons played after surgery, RTP, and complications. RTP was defined as the ability to play in a single regular-season NFL game after surgery. At the time of surgery, average age for all patients was 24.0 years and BMI 31.0. Results: Player positions included 8 wide receivers, 4 linebackers, 4 tight ends, 2 defensive tackles, 2 cornerbacks, 1 offensive tackle, 1 center, 1 tackle, 1 defensive end, and 1 quarterback. Seventy-six percent of players underwent operative fixation during their first 3 seasons. Forty-eight percent were diagnosed before or during their rookie (first) season. RTP was 100% for all players and 80% were still playing at time of publication. Three patients (12.0%) refractured and required revision surgery. Time until RTP was influenced by other variables and difficult to measure because many surgeries were performed early in the offseason. All 9 players who underwent surgery between July and October, and were therefore eligible to return to play in the same season, had an average RTP of 8.7 weeks (range 5.9-13.6). Conclusion: With an appropriately placed intramedullary screw and an aggressive rehabilitation protocol, early RTP was achievable with a low refracture rate in professional athletes. All NFL players in this series were able to return to play after surgery. We observed that these injuries were more likely to occur in the first 3 seasons of play and in wide receivers, linebackers, and tight ends. This at-risk subset of players may benefit from improved preventative measures. Level of Evidence: Level IV, retrospective case series.